Trends in the Management and Outcomes of Acute Pulmonary Embolism: Analysis From the RIETE Registry

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• 作者：David Jimé ; nez ; PhD^&lowast ; ; ^{djimenez.hrc@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Javier de Miguel-Dí ; ez ; PhD^&dagger ; ; Ricardo Guijarro ; MD^&Dagger ; ; Javier Trujillo-Santos ; PhD^§ ; ; Remedios Otero ; PhD^‖ ; Raquel Barba ; PhD^¶ ; ; Alfonso Muriel ; PhD^# ; Guy Meyer ; PhD^&lowast ; &lowast ; ; Roger D. Yusen ; MD^&dagger ; &dagger ; ; Manuel Monreal ; PhD^&Dagger ; &Dagger ; ; for the RIETE Investigators
• 关键词：heparin ; length of stay ; outcomes ; prognosis ; surgical embolectomy ; survival ; thrombolysis
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：19 January 2016
• 年：2016
• 卷：67
• 期：2
• 页码：162-170
• 全文大小：986 K

文摘

Despite advances in hospital management in recent years, it is not clear whether mortality after acute pulmonary embolism (PE) has decreased over time.

Objectives

This study describes the trends in the management and outcomes of acute symptomatic PE.

Methods

We identified adults with acute PE enrolled in the registry between 2001 and 2013. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies. Using multivariable regression, we examined temporal trends in risk-adjusted rates of all-cause and PE-related death to 30 days after diagnosis.

Results

Among 23,858 patients with PE, mean length of stay decreased from 13.6 to 9.3 days over time (32% relative reduction, p < 0.001). For initial treatment, use of low-molecular-weight heparin increased from 77% to 84%, whereas the use of unfractionated heparin decreased from 22% to 8.4% (p < 0.001 for trend for all comparisons). Thrombolytic therapy use increased from 0.7% to 1.0% (p = 0.07 for trend) and surgical embolectomy use doubled from 0.3% to 0.6% (p < 0.01 for trend). Risk-adjusted rates of all-cause mortality decreased from 6.6% in the first period (2001 to 2005) to 4.9% in the last period (2010 to 2013) (p = 0.02 for trend). Rates of PE-related mortality decreased over time, with a risk-adjusted rate of 3.3% in 2001 to 2005 and 1.8% in 2010 to 2013 (p < 0.01 for trend).

Conclusions

In a large international registry of patients with PE, improvements in length of stay and changes in the initial treatment were accompanied by a reduction in short-term all-cause and PE-specific mortality.