TY - JOUR
T1 - Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism
T2 - Evidence From Meta-Analysis of 65,589 Patients
AU - Pietrasik, Arkadiusz
AU - Gąsecka, Aleksandra
AU - Szarpak, Łukasz
AU - Pruc, Michał
AU - Kopiec, Tomasz
AU - Darocha, Szymon
AU - Banaszkiewicz, Marta
AU - Niewada, Maciej
AU - Grabowski, Marcin
AU - Kurzyna, Marcin
N1 - Funding Information: This manuscript was supported by the Centre of Postgraduate Medical Education, project number 501-1-054-25-22. Publisher Copyright: Copyright © 2022 Pietrasik, Gąsecka, Szarpak, Pruc, Kopiec, Darocha, Banaszkiewicz, Niewada, Grabowski and Kurzyna.
PY - 2022/6/16
Y1 - 2022/6/16
N2 - Background: Catheter-directed therapies (CDT) are an alternative to systemic thrombolysis (ST) in pulmonary embolism (PE) patients, but the mortality benefit of CDT is unclear. Objective: We conducted a systematic review with meta-analysis to compare the efficacy and safety of CDT and ST in intermediate-high and high-risk PE. Methods: We included (P) participants, adult PE patients; (I) intervention, CDT; (C) comparison, ST; (O) outcomes, mortality, complications, in-hospital treatment, and length of hospital stay; (S) study design, randomized controlled trials (RCTs), or cohort comparing CDT and ST. The primary endpoint was 30-day mortality. Secondary outcomes included treatment-related complications including bleeding, the use of hospital resources, and length of hospital stay. Results: Eleven studies including 65,589 patients met the inclusion criteria. Thirty-day mortality was lower in the CDT group, compared to ST group [7.3 vs. 13.6%; odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.38–0.69, p < 0.001]. The rates of myocardial injury, cardiac arrest, and stroke were lower in CDT group, compared to ST group (p < 0.001 for all). The rates of any major bleeding, intracranial hemorrhage, hemoptysis, and red blood cell transfusion were lower in patients treated with CDT, compared to ST (p ≤ 0.01 for all). Extracorporeal life support was used more often in patients treated with CDT, compared to ST (0.5 vs. 0.2%, OR = 2.52, 95% CI 1.88–3.39, p < 0.001). The use of hospital resources and length of hospital stay were comparable in both groups. Conclusion: CDT might decrease mortality in patients with intermediate-high and high-risk PE and were associated with fewer complications, including major bleeding.
AB - Background: Catheter-directed therapies (CDT) are an alternative to systemic thrombolysis (ST) in pulmonary embolism (PE) patients, but the mortality benefit of CDT is unclear. Objective: We conducted a systematic review with meta-analysis to compare the efficacy and safety of CDT and ST in intermediate-high and high-risk PE. Methods: We included (P) participants, adult PE patients; (I) intervention, CDT; (C) comparison, ST; (O) outcomes, mortality, complications, in-hospital treatment, and length of hospital stay; (S) study design, randomized controlled trials (RCTs), or cohort comparing CDT and ST. The primary endpoint was 30-day mortality. Secondary outcomes included treatment-related complications including bleeding, the use of hospital resources, and length of hospital stay. Results: Eleven studies including 65,589 patients met the inclusion criteria. Thirty-day mortality was lower in the CDT group, compared to ST group [7.3 vs. 13.6%; odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.38–0.69, p < 0.001]. The rates of myocardial injury, cardiac arrest, and stroke were lower in CDT group, compared to ST group (p < 0.001 for all). The rates of any major bleeding, intracranial hemorrhage, hemoptysis, and red blood cell transfusion were lower in patients treated with CDT, compared to ST (p ≤ 0.01 for all). Extracorporeal life support was used more often in patients treated with CDT, compared to ST (0.5 vs. 0.2%, OR = 2.52, 95% CI 1.88–3.39, p < 0.001). The use of hospital resources and length of hospital stay were comparable in both groups. Conclusion: CDT might decrease mortality in patients with intermediate-high and high-risk PE and were associated with fewer complications, including major bleeding.
KW - PERT
KW - catheter-based therapies
KW - meta-analysis
KW - pulmonary embolism
KW - pulmonary embolism response team
UR - http://www.scopus.com/inward/record.url?scp=85138514238&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fcvm.2022.861307
DO - https://doi.org/10.3389/fcvm.2022.861307
M3 - Review article
C2 - 35783825
SN - 2297-055X
VL - 9
JO - Frontiers in cardiovascular medicine
JF - Frontiers in cardiovascular medicine
M1 - 861307
ER -