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Poor prognosis in patients with acute pulmonary embolism treated with mechanical thrombectomy
Session:
Sessão de Posters 02 - Embolia Pulmonar
Speaker:
Inês Rodrigues
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Inês Rodrigues; Inês Neves; António Gonçalves; Marta Leite; Fábio Nunes; Rafael Teixeira; Pedro Braga; Ricardo Fontes Carvalho
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Acute pulmonary embolism (PE) is associated with high mortality and morbidity rates. Percutaneous catheter-based treatments have emerged as a viable alternative for treating this condition, alongside thrombolysis. </span></span></p> <p><strong><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Aim: </span></span></strong><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The aim of this study is to evaluate the outcomes of patients with acute PE refered for mechanical trombectomy.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> From January 2016 and August 2023, all patients referred to a tertiary centre for pulmonary angiography with the intent of undergoing mechanical thrombectomy for acute PE were retrospectively included. Clinical data and outcomes were collected.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Fifty-two patients (58% female; mean age 66±18 years) were referred to pulmonary angiography in the setting of acute PE, of whom 40 patients (77%) underwent continuous aspiration mechanical thrombectomy with an overall success rate of 70%. Twenty-eight percent of patients had bilateral thrombus. Thirty-two patients had intermediate-high risk or high-risk PE, and the mean Pulmonary Embolism Severity Index (PESI) was 146 points. Thirteen patients (25%) underwent thrombolysis prior to angiography, while 15 patients (28%) had an absolute or relative contraindication for thrombolysis.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Ventilation/perfusion scans were performed in ten patients (19%) during the follow-up period, of whom five patients (10%) had evidence of residual illness, with no significant differences between the thrombectomy and non-thrombectomy groups (p=0.8).</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The overall mortality rate over the complete follow-up period was 39%, while 25% of patients died within 48 hours of the procedure. Predictors of mortality on univariate analysis included older age (HR 1.06 [95% CI 1.00-1.11, p = 0.03]), history of chronic obstructive pulmonary disease (HR 3.88 [95% CI 1.41-10.69, p = 0.01]), history of previous deep vein thrombosis or PE (HR 3.40 [95% CI 1.34-8.63, p = 0.01]), thrombolysis prior to referral for mechanical thrombectomy (HR 5.94 [95% CI 1.93-18.26, p <0.01), shock or haemodynamic instability (HR 8.50 [95% CI 2.44-29,52, p <0.01]) and resuscitated cardiac arrest (HR 5.98 [95% CI 2.34-15.30, p <0.01]). On Cox multivariate analysis, the presence of shock or haemodynamic instability was a predictor of increased mortality (HR 5.23 [95% CI 1.12-24.3, p = 0.04]).</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> Intermediate and high risk acute PE is associated with high morbidity and mortality rate regardless of treatment strategy. This is particularly evident during the index hospitalization, especially in clinical and hemodynamic unstable patients.</span></span></p>
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