Treatment of High- and Intermediate-High-Risk Pulmonary Embolism by the Pulmonary Embolism Response Team: Focus on Catheter-Directed Therapies

Authors

Arkadiusz Pietrasik
Paweł Kurzyna
Piotr Szwed
Karolina Jasińska-Gniadzik
Aleksandra Gąsecka
Szymona Darocha
Dariusz Zieliński
Łukasz Szarpak
Janusz Kochman
Marcin Grabowski
Grzegorz Opolski
Adam Torbicki
Marcin Kurzyna

Publication Date

1-1-2024

Journal

Journal of the American College of Cardiology

DOI

10.5603/CJ.a2023.0047

PMID

37519055

PMCID

PMC11076036

PubMedCentral® Posted Date

4-26-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Pulmonary Embolism, Male, Female, Retrospective Studies, Thrombolytic Therapy, Middle Aged, Treatment Outcome, Aged, Embolectomy, Risk Assessment, Risk Factors, Patient Care Team, Anticoagulants, Fibrinolytic Agents, catheter-directed therapies, high-risk pulmonary embolism, intermediate-high-risk pulmonary embolism, pulmonary embolism, Pulmonary Embolism Response Team

Abstract

BACKGROUND: Multidisciplinary Pulmonary Embolism Response Teams (PERTs) were established to individualize the treatment of high-risk (HR) and intermediate-high-risk (IHR) pulmonary embolism (PE) patients, which pose a challenge in clinical practice.

METHODS: We retrospectively collected the data of all HR and IHR acute PE patients consulted by PERT CELZAT between September 2017 and October 2022. The patient population was divided into four different treatment methods: anticoagulation alone (AC), systemic thrombolysis (ST), surgical embolectomy (SE), and catheter-directed therapies (CDTx). Baseline clinical characteristics, risk stratification, PE severity parameters, and treatment outcomes were compared between the four groups.

RESULTS: Of the 110 patients with HR and IHR PE, 67 (61%) patients were treated with AC only, 11 (10%) with ST, 15 (14%) underwent SE, and 17 (15%) were treated with CTDx. The most common treatment option in the HR group was reperfusion therapy, used in 20/24 (83%) cases, including ST in 7 (29%) patients, SE in 5 (21%) patients, and CTDx in 8 (33%) patients. In contrast, IHR patients were treated with AC alone in 63/86 (73%) cases. The in-hospital mortality rate was 9/24 (37.5%) in the HR group and 4/86 (4.7%) in the IHR group.

CONCLUSIONS: The number of advanced procedures aimed at reperfusion was substantially higher in the HR group than in the IHR PE group. Despite the common use of advanced reperfusion techniques in the HR group, patient mortality remained high. There is a need further to optimize the treatment of patients with HR PE to improve outcomes.