Ultrasound-assisted catheter-directed thrombolysis versus anticoagulation alone for management of submassive pulmonary embolism

Authors

Sarah Gorgis, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.
Sagger Mawri, Premier Cardiovascular Institute, Dayton, OH, USA.
Mohammed F. Dabbagh, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.
Lindsey Aurora, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.
Mahmoud Ali, Advocate Aurora HealthFollow
Giordano Mitchell, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA.
Gordon Jacobsen, Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA.
Sara Hegab, Division of Pulmonary and Critical Care, Henry Ford Hospital, Detroit, MI, USA; Wayne State University School of Medicine, Detroit, MI, USA.
Scott Schwartz, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA.
Bryan Kelly, Division of Pulmonary and Critical Care, Henry Ford Hospital, Detroit, MI, USA.
Gillian Grafton, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA; Division of Pulmonary and Critical Care, Henry Ford Hospital, Detroit, MI, USA.
Rana Awdish, Division of Pulmonary and Critical Care, Henry Ford Hospital, Detroit, MI, USA; Wayne State University School of Medicine, Detroit, MI, USA.Follow
Reem Ismail, Division of Pulmonary and Critical Care, Henry Ford Hospital, Detroit, MI, USA.
Gerald Koenig, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA; Wayne State University School of Medicine, Detroit, MI, USA. Electronic address: gkoenig1@hfhs.org.

Recommended Citation

Gorgis S, Mawri S, Dabbagh MF, et al. Ultrasound-assisted catheter-directed thrombolysis versus anticoagulation alone for management of submassive pulmonary embolism. J Cardiol. 2022;80(5):441-448. doi:10.1016/j.jjcc.2022.04.008

Affiliations

Aurora Cardiovascular and Thoracic Services

Abstract

Background: Patients with submassive pulmonary embolism (PE) are vulnerable to sudden deterioration, recurrent PE, and progression to pulmonary hypertension and chronic right ventricular (RV) dysfunction. Previous studies have suggested a clinical benefit of using ultrasound-assisted catheter-directed thrombolysis (USCDT) to invasively manage patients with submassive PE. However, there is sparse data comparing the clinical outcomes of these patients when treated with USCDT versus anticoagulation (AC) alone. We sought to compare the outcomes of USCDT versus AC alone in the management of submassive PE.

Methods: 192 consecutive patients who underwent USCDT for submassive PE between January 2013 and February 2019 were identified. ICD9/ICD10 codes were used to detect 2554 patients diagnosed with PE who did not undergo thrombolysis. Propensity matching identified 192 patients with acute PE treated with AC alone. Clinical outcomes were compared between the two groups. Baseline demographics, laboratory values, and pulmonary embolism severity index scores were similar between the two cohorts.

Results: There was a significant reduction in mean systolic pulmonary artery pressure (sPAP) in the USCDT group compared to the AC group (∆11 vs ∆3.9 mmHg, p < 0.001). There was significant improvement in proportion of RV dysfunction in all patients, but the difference was larger in the USCDT group (∆43.3% vs ∆17.3%, p < 0.001). Patients who underwent USCDT had lower 30-day (4.3% vs 10.5%, p = 0.03), 90-day (5.5% vs 12.4%, p = 0.03), and 1-year mortality (6.2% vs 14.2%, p = 0.03).

Conclusions: In patients with acute submassive PE, USCDT was associated with improved 30-day, 90-day, and 1 year mortality as compared to AC alone. USCDT also improved RV function and reduced sPAP to a greater degree than AC alone. Further studies are needed to verify these results in both short- and long-term outcomes.

Type

Article

PubMed ID

35643741