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CATHETER-DIRECTED THROMBOLYSIS (CDT) VERSUS THROMBOLYSIS TO TREAT PULMONARY EMBOLISM: A PROPENSITY SCORE-MATCHED ANALYSIS FROM THE NATIONWIDE INPATIENT SAMPLE
A1552 JACC March 17, 2015 Volume 65, Issue 10S
Pulmonary Hypertension and Venous Thrombo-embolic Disease Catheter-Directed Thrombolysis (CDT) versus Thrombolysis to Treat Pulmonary Embolism: A Propensity Score-Matched Analysis from the Nationwide Inpatient Sample Poster Contributions Poster Hall B1 Sunday, March 15, 2015, 9:45 a.m.-10:30 a.m. Session Title: Evaluation and Therapy of Pulmonary Embolism Abstract Category: 24. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease Presentation Number: 1181-172 Authors: Nish Patel, Nileshkumar Patel, Badal Thakkar, Nilay Patel, Shilpkumar Arora, Ankit Chothani, Vikas Singh, Sunny Jhamnani, Sidakpal Panaich, Abhishek Deshmukh, Apurva Badheka, Carlos Alfonso, University of Miami Miller School of Medicine, Miami, FL, USA
Background: The role of catheter-directed thrombolysis in the treatment of pulmonary embolism is controversial, and real world outcomes are unknown. Methods: We used Nationwide Inpatient Sample database from 2000 to 2012 to identify all patients aged ≥ 18 years with PE. We compared patients treated with CDT against the patients treated with thrombolysis alone. We used propensity score to construct two matched group for outcomes analysis.
Results: Of 6,903 patients with PE, 1,507 were treated with CDT and 5,396 patients were treated with thrombolysis alone. Unmatched comparison demonstrated in-hospital mortality of 23.8% and 10.6% in patients managed with CDT vs. thrombolysis alone, respectively (P <0.001). We analyzed 3,939 patients with 1:2 propensity score matched pairs among CDT and thrombolysis group. After propensity matching, in-hospital mortality was 23.8% with CDT and 11.4% with thrombolysis alone [OR 2.445, 95% CI 2.052-2.913, P <0.001] and length of stay was longer in CDT group [10.72 days vs. 7.81 days (OR 1.048, 95% CI 1.037-1.058, P <0.001)].
Conclusion: In this large observation study with propensity score-matched analysis, we found that CDT is associated with higher mortality and length of stay compared to thrombolysis alone. Further randomized trial with outcomes such as mortality and chronic thromboembolic pulmonary hypertension is needed to address this difference in effectiveness.
Pulmonary Hypertension and Venous Thrombo-embolic Disease Catheter-Directed Thrombolysis (CDT) versus Thrombolysis to Treat Pulmonary Embolism: A Propensity Score-Matched Analysis from the Nationwide Inpatient Sample Poster Contributions Poster Hall B1 Sunday, March 15, 2015, 9:45 a.m.-10:30 a.m. Session Title: Evaluation and Therapy of Pulmonary Embolism Abstract Category: 24. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease Presentation Number: 1181-172 Authors: Nish Patel, Nileshkumar Patel, Badal Thakkar, Nilay Patel, Shilpkumar Arora, Ankit Chothani, Vikas Singh, Sunny Jhamnani, Sidakpal Panaich, Abhishek Deshmukh, Apurva Badheka, Carlos Alfonso, University of Miami Miller School of Medicine, Miami, FL, USA
Background: The role of catheter-directed thrombolysis in the treatment of pulmonary embolism is controversial, and real world outcomes are unknown. Methods: We used Nationwide Inpatient Sample database from 2000 to 2012 to identify all patients aged ≥ 18 years with PE. We compared patients treated with CDT against the patients treated with thrombolysis alone. We used propensity score to construct two matched group for outcomes analysis.
Results: Of 6,903 patients with PE, 1,507 were treated with CDT and 5,396 patients were treated with thrombolysis alone. Unmatched comparison demonstrated in-hospital mortality of 23.8% and 10.6% in patients managed with CDT vs. thrombolysis alone, respectively (P <0.001). We analyzed 3,939 patients with 1:2 propensity score matched pairs among CDT and thrombolysis group. After propensity matching, in-hospital mortality was 23.8% with CDT and 11.4% with thrombolysis alone [OR 2.445, 95% CI 2.052-2.913, P <0.001] and length of stay was longer in CDT group [10.72 days vs. 7.81 days (OR 1.048, 95% CI 1.037-1.058, P <0.001)].
Conclusion: In this large observation study with propensity score-matched analysis, we found that CDT is associated with higher mortality and length of stay compared to thrombolysis alone. Further randomized trial with outcomes such as mortality and chronic thromboembolic pulmonary hypertension is needed to address this difference in effectiveness.