Catheter Based Interventions versus Medical and Surgical Approaches in Acute Pulmonary Embolism
Catheter-based interventions have become increasingly popular treatments for acute pulmonary embolism (PE) but it is unclear whether these interventions result in reduced mortality rates or other positive patient outcomes. To address this question, physicians and surgeons at the University of Maryland Medical Center compared the outcomes of catheter-based interventions to traditional medical and surgical approaches in patients with acute PE.
The team of experts, led by Rafael S. Cires-Drouet, MD, performed a retrospective analysis of 108 adult patients who presented with acute PE between October 2015 and December 2017. Thirty patients who received catheter-based interventions were compared to a control group of 78, which included both surgical (16 patients) and medical (62 patients) approaches. Patients who received surgical pulmonary embolectomy were included in the surgical control group, and patients who did not undergo surgery were included in the medical group. All of the patients studied were clinically similar, with the exception of body mass index, which was higher in the group that received catheter-based interventions.
Outcomes studied included mortality, both in-hospital and overall, as well as major bleeding, length of stay, recurrent PE, thrombus resolution, and right ventricle improvement in systolic function and dilatation.
The retrospective study revealed that catheter-based interventions were associated with a higher mortality rate than the surgical approach. However, catheter-based interventions did result in fewer recurrent PEs than the medical approach did.
Compared to the medical group, the group receiving catheter-based interventions had a slightly lower rate of recurrent PE (0 percent compared to 6.4 percent in the medical group). Outcomes were otherwise similar. The surgical group had a lower mortality rate (0 percent) compared to the group receiving catheter-based interventions (16.6 percent). The surgical group was also associated with a longer length of stay (median 8 days compared to median 7 days with catheter-based interventions).
The study authors concluded that for high-risk PE patients, a surgical approach might be a better option than catheter-based interventions, which resulted in outcomes similar to the medical approach. Surgical pulmonary embolectomy is a strong option that should always be considered for acute PE.
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