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Prognostic risk factors in catheter-directed therapies in intermediate-high risk acute pulmonary embolism
Session:
Posters (Sessão 5 - Écran 6) - Tromboembolismo pulmonar
Speaker:
João Mirinha Luz
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:
Pósters Electrónicos
FP Number:
---
Authors:
João Mirinha Luz; Rita Calé Theotónio; Filipa Ferreira; Sofia Alegria; Cristina Martins; Gonçalo Morgado; Ana Rita Pereira; Mariana Martinho; Melanie Ferreira; Ana Gomes; Tiago Judas; Filipe Gonzalez; Corinna Lohmann; Débora Repolho; Pedro Santos; Ernesto Pereira; Hélder Pereira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Introduction:</u></strong> Intermediate-high risk pulmonary embolism (IHRPE) is a major cause of morbidity and mortality, but in recent years, introduction of catheter-based therapies (CDT) brought hope and interesting results. Systemic fibrinolysis is still the first line in those patients (pts) when systemic anticoagulation fails, but CDT is emerging as a safe and effective alternative. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Methods:</u></strong> A retrospective single center analysis of IHRPE pts subjected to CDT since 2018 was conducted. CDT used were either catheter-directed thrombolysis with Cragg-McNamara 5Fr device (1mg/h of alteplase), mechanical thrombectomy using the Indigo system (Penumbra 8Fr) or Teleflex’ Pronto extraction system. Death by any cause, intra-hospital mortality and death within 30 days of index event were analysed. Pre-procedure clinical, imaging and laboratorial indicators were used.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results:</u></strong> A total of 30pts were subjected to CDT therapies, with more than half (56.7, n=17) treated with Penumbra system. Mean age was 65.7 years-old [standard deviation (SD) 15.9], with a large majority of female pts (70%, n=21). Mean PESI score was 111.9 (SD 40.8). Severe adverse events during CDT were observed in 13.3% (4pts, 2 deaths during the procedure). Increased serum lactate [4.5 (IQR 5.4) vs 1.9 (IQR 4.0), p=0.017<span style="font-size:13.0pt">]</span> and lower cardiac frequency (88.3 +- 22.9 vs 113.1 +- 19.1, p=0.048) were associated with higher intra-hospital mortality. Similar results were obtained regarding higher 30-day mortality. No clinical, imaging or laboratorial indicators showed statistical significance regarding death by any cause (table 1). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Conclusion:</u></strong> Pre-procedure clinical and laboratorial indicators showed potential for prognostic evaluation when assessing patients for CDT and their response to these therapies. Due to a reduced sample, other factors cannot be adequately assessed for prognostic evaluation, emphasizing the need for larger studies. </span></span></p>
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