Catheter-directed treatment for acute pulmonary embolism: Systematic review and single-arm meta-analyses

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• 作者：Navkaranbir S. Bajaj^a ; ^b ; ^j ; ¹ ; Rajat Kalra^c ; ^k ; ¹ ; Pankaj Arora^a ; Sameer Ather^a ; Jason L. Guichard^a ; W. Jake Lancaster^c ; Nirav Patel^a ; Fabio Raman^d ; Garima Arora^a ; Firas Al Solaiman^a ; D. Trey Clark III^e ; Louis J. Dell'Italia^a ; ^f ; Massoud A. Leesar^a ; James E. Davies^g ; David C. McGiffin^h ; Mustafa I. Ahmed^a ; ⁱ ; ^{musiahm@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AT ; aspiration thrombectomy ; CDT ; catheter-directed treatment ; HI ; haemodynamic instability ; HS ; haemodynamic stability ; IT ; intrapulmonary thrombolysis ; MF ; mechanical fragmentation ; mmHg ; millimetres of mercury ; mPAP ; mean pulmonary artery pressure ; PE ; pulmonary embolism ; RT ; rheolytic thrombectomy ; Unstable haemodynamic status ; studies where all patients had acute pulmonary embolism causing right ventricular dysfunction and haemodynamic instability. ; Stable and unstable haemodynamic status
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 December 2016
• 年：2016
• 卷：225
• 期：Complete
• 页码：128-139
• 全文大小：991 K

文摘

We sought to estimate the efficacy and safety outcomes of catheter-directed treatment (CDT) for patients with acute pulmonary embolism (PE).

Methods

We searched SCOPUS for studies reporting outcomes after CDT for acute PE. Studies were categorized in three groups for analyses due to heterogeneity in the classification of acute PE: 1) patients with PE causing right ventricular dysfunction and haemodynamic instability: unstable haemodynamic status, 2) patients with PE causing right ventricular dysfunction where study outcomes were not stratified by haemodynamic status: stable and unstable haemodynamic status, and 3) patients with PE causing right ventricular dysfunction who remained haemodynamically stable: stable haemodynamic status. Efficacy and safety outcomes were estimated and presented as point estimates with 95% confidence intervals.

Results

In 35 studies with 1253 patients, 1277 CDTs were performed. The in-hospital mortality rates for the unstable haemodynamic status, stable and unstable haemodynamic status, and stable haemodynamic status groups were 18.1% (7.3–38.2%), 7.1% (5.0–10.1%), and 2.6% (0.8–7.3%), respectively. The major bleeding rates across the groups were estimated to be 4.5, 8.5 and 3.9 per 100 CDTs, respectively. Minor bleeding occurred in 6.2, 11.9 and 9.1 per 100 CDTs, respectively. After CDT, all groups had improvements in mean pulmonary artery pressure and right ventricular function.

Conclusions

We provide descriptive measures of efficacy and safety for patients who underwent CDT for acute PE.