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首页> 外文期刊>The American Journal of Cardiology >Catheter-Directed Thrombolysis in Submassive Pulmonary Embolism and Acute Cor Pulmonale
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Catheter-Directed Thrombolysis in Submassive Pulmonary Embolism and Acute Cor Pulmonale

机译：管脑栓塞和急性肺部脉栓的导管导向溶栓

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摘要

Treatment of submassive (intermediate-risk) pulmonary embolism (PE), defined as hemodynamically stable with right ventricular (RV) dysfunction, showed lower in-hospital all-cause mortality with intravenous thrombolytic therapy than with anticoagulants, but at an increased risk of major bleeding. The present investigation was performed to test whether catheter-directed thrombolysis reduces mortality without increasing bleeding in submassive PE. This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample. In 2016, 13,130 patients were hospitalized with PE and acute cor pulmonale, were stable, and treated with catheter-directed thrombolysis in 1,500 (11%) or anticoagulants alone in 11,630 (89%). Mortality was lower with catheter-directed thrombolysis than with anticoagulants in unmatched patients, 35 of 1,500 (2.3%) compared with 755 of 11,630 (6.5%; p < 0.0001) and in matched patients, 30 of 1,260 (2.4%) compared with 440 of 6,910 (6.4%; p < 0.0001). Time-dependent analysis showed catheter-directed thrombolysis reduced mortality if administered within the first 3 days. Patients with saddle PE treated with anticoagulants had lower mortality than non-saddle PE, 75 of 1,730 (4.3%) compared with 680 of 9,900 (6.9%; p < 0.0001) in unmatched patients and 45 of 1,305 (3.4%) compared with 395 of 5,605 (7.0%; p < 0.0001) in matched patients. Mortality was not lower with inferior vena cava filters either in those who received catheter-directed thrombolysis or those treated with anticoagulants. There were no fatal or nonfatal adverse events associated with catheter-directed thrombolysis. In conclusion, patients with submassive PE appear to have lower in-hospital all-cause mortality with catheter-directed thrombolysis administered within 3 days than with anticoagulants, and risks are low. (C) 2020 Elsevier Inc. All rights reserved.
机译：亚重度（中等风险）肺栓塞（PE）被定义为血流动力学稳定伴右心室（RV）功能障碍，静脉溶栓治疗的院内全因死亡率低于抗凝剂治疗，但大出血风险增加。本研究旨在检测导管导向溶栓是否能在不增加出血的情况下降低亚重度PE患者的死亡率。这是一项基于全国住院患者样本管理数据的回顾性队列研究。2016年，13130名患者因PE和急性肺心病住院，病情稳定，1500名患者（11%）接受了导管导向溶栓治疗，11630名患者（89%）仅接受了抗凝剂治疗。在不匹配患者中，导管导向溶栓治疗的死亡率低于抗凝剂治疗的死亡率，1500例患者中有35例（2.3%）低于11630例患者中的755例（6.5%；p<0.0001），在匹配患者中，1260例患者中有30例（2.4%）低于6910例患者中的440例（6.4%；p<0.0001）。时间依赖性分析显示，如果在前3天内进行导管导向溶栓治疗，死亡率会降低。接受抗凝剂治疗的鞍型PE患者的死亡率低于非鞍型PE患者，非匹配患者1730例中有75例（4.3%）死亡率低于9900例中的680例（6.9%；p<0.0001），匹配患者1305例中有45例（3.4%）死亡率低于5605例中的395例（7.0%；p<0.0001）。接受导管定向溶栓或抗凝剂治疗的患者，使用下腔静脉滤器的死亡率并不低。没有与导管导向溶栓相关的致命或非致命性不良事件。总之，与抗凝剂相比，在3天内进行导管定向溶栓治疗的亚重度PE患者的院内全因死亡率较低，且风险较低。（C） 2020爱思唯尔公司版权所有。

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