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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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Acute and middle-term outcomes of intermediate-high-risk acute pulmonary embolism patients submitted to catheter-based therapy - a single-centre pilot study
Session:
Comunicações Orais - Sessão 20 - Tromboembolismo pulmonar agudo
Speaker:
Mariana Sousa Paiva
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Sousa Paiva; Sílvio Leal; Daniel A. Gomes; Francisco Albuquerque; Afonso Félix de Oliveira; João Brito; Nélson Vale; Sérgio Madeira; Luís Raposo; Eduardo Infante Oliveira; Pedro de Araújo Gonçalves; Henrique Mesquita Gabriel; Rui Campante Teles; Manuel Sousa Almeida; Miguel Mendes
Abstract
<p>Background: The increasing evidence of efficacy and safety of catheter-based approaches is changing the treatment paradigm of acute pulmonary embolism (PE). However, the demonstration of their clear prognostic benefit in intermediate-risk patients is still lacking. Our aim was to evaluate the acute and middle-term outcomes of patients with intermediate-high-risk acute PE submitted to catheter-based therapy.</p> <p> </p> <p>Methods: Retrospective analysis of a single centre cohort study of patients with acute PE of intermediate-high-risk, undergoing percutaneous therapy through mechanical thrombectomy (MT), catheter-derived thrombolysis (CDL) or combined technique. PESI and sPESI scores at admission were calculated. Efficacy endpoints were defined as the change in systolic pulmonary artery pressure (sPAP), heart rate (bpm), systolic blood pressure (SBP) and peripheral oxygen saturation (SpO2) from baseline and 48 hours (mmHg). Safety endpoints were defined as rate of major adverse events, i.e., a composite of death, major bleeding, and device-related serious adverse events (SAE) (intraprocedural clinical deterioration, pulmonary vascular injury, and cardiac injury), at 30 days (%).</p> <p> </p> <p>Results: From December 2019 to October 2022, 41 patients were submitted to catheter-based therapy for acute PE of intermediate-high-risk, 25 (61%) females, mean age of 60±17 years old. At admission, all patients had RV dilatation and high serum troponin, and the majority (90%) exhibited RV systolic dysfunction. The average PESI was 110±24, and average sPESI was >1. In total, 10 patients underwent MT, 9 CDL and 22 a combined technique. The average procedure time was 115±61 min. At 48h follow-up, sPAP (59 vs. 40 mmHg, p<0.0001), HR (110±20 vs. 85±15 bpm, p<0.0001) and SpO2 (91±6% vs. 97±2%, p<0.001) were significantly reduced, whereas systolic blood pressure (125±21 vs. 124±21 mmHg, p=0.858) did not differ significantly.</p> <p>In terms of safety at 30 days, the composite endpoint was observed in 15% (n = 7) of the patients, composed by 3 deaths, 2 non-fatal major bleedings, and 2 additional device-related SAE.</p> <p> </p> <p>Conclusion: In our series, catheter-based therapy for intermediate-high-risk acute pulmonary embolism showed good acute and middle-term efficacy and safety results with a low 30-day mortality rate. Further studies with a broader population will reinforce these findings.</p>
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