目的:检查导管溶栓(CDT)与导管引导栓子切除术(CDE)用于高危肺栓塞(PE)。
背景:CDE与CDE的短期结果比较数据高危PE患者的CDT很少。
方法:利用全国再入院数据库来确定2016年至2019年接受CDE或CDT的高危PE住院情况。感兴趣的主要结果是全因住院死亡率。使用倾向评分匹配比较两组的结果。
结果:在接受导管定向干预的3,216例高危PE住院患者中,868名(27%)收到CDE,1,864(58%)接受了CDT,484(15%)接受了这两个程序。在未经调整的分析中,全因住院死亡率不在CDE和CDT之间(39.6%vs.34.2%,P=0.07)。在倾向得分匹配后,CDE与较高的死亡率无关(调整后的比值比[OR]1.28,95%置信区间[CI]0.95,1.72,P=0.10),颅内出血(ICH)(校正OR1.57,95%CI0.75,3.29,P=0.23)或非ICH出血(校正OR1.17,95%CI0.85,1.62,P=0.33).停留时间没有差异,两组之间的成本和30天非计划再入院。
结论:在对接受CDT或CDE的高危PE患者进行的当代观察性分析中,住院死亡率,ICH和非ICH出血事件没有差异。
OBJECTIVE: To examine the shot-term outcomes with catheter-directed thrombolysis (CDT) vs. catheter-directed embolectomy (
CDE) for high-risk pulmonary embolism (PE).
RESULTS: The Nationwide Readmissions Database was utilized to identify hospitalizations with high-risk PE undergoing
CDE or CDT from 2016 to 2019. The main outcome was all-cause in-hospital mortality. Propensity score matching was used to compare the outcomes in both groups. Among 3216 high-risk PE hospitalizations undergoing catheter-directed interventions, 868 (27%) received
CDE, 1864 (58%) received CDT, and 484 (15%) received both procedures. In the unadjusted analysis, the rate of all-cause in-hospital mortality was not different between
CDE and CDT (39.6% vs. 34.2%, P = 0.07). After propensity score matching, there was no difference in the incidence of in-hospital mortality [adjusted odds ratio (aOR): 1.28, 95% confidence interval (CI): 0.95, 1.72, P = 0.10], intracranial haemorrhage (ICH) (adjusted OR 1.57, 95% CI: 0.75, 3.29, P = 0.23), or non-ICH bleeding (aOR: 1.17, 95% CI: 0.85, 1.62, P = 0.33). There were no differences in the length of stay, cost, and 30-day unplanned readmissions between both groups.
CONCLUSIONS: In this contemporary observational analysis of patients admitted with high-risk PE undergoing CDT or
CDE, the rates of in-hospital mortality, ICH, and non-ICH bleeding events were not different.