Author + information
- Behnood Bikdeli,
- David Jimenez,
- Alfonso Muriel,
- Deisy Barrios,
- Aitor Ballaz,
- Peter Verhamme and
- Manuel Monreal
Right heart thrombi (RHT) portend worse outcomes in patients with pulmonary embolism (PE) but the optimal management remains unknown.
Using the data from a prospective multinational PE registry (2001-2019), we determined the use of reperfusion therapies (thrombolytic therapy, or percutaneous or surgical thrombectomy) in patients with PE+RHT, and compared the main outcomes (30-day PE-related mortality, all-cause mortality, major bleeding, recurrent PE) with or without reperfusion. In the primary analysis, 1:1 propensity score matching was used. We used Multivariable logistic regression in confirmatory analyses.
Among 42,620 patients with PE, 443 had RHT, of whom 102 received reperfusion therapy. Overall, 40 (9.0%) patients died, including 24 (5.4%) from PE. In propensity-matched analysis, use of reperfusion therapy was associated with non-significantly reduced odds of PE-related mortality (OR: 0.65, 95% CI: 0.20-2.16, P=0.48) and all-cause mortality (OR: 0.86, 95% CI: 0.30-2.43, P=0.78), comparable odds of major bleeding (OR: 1.00, 95% CI: 0.25-3.92, P=0.99) and an increase in recurrent PE (risk difference: 0.08, 95% CI: 0.02-0.14). Findings were similar in confirmatory regression analyses (Figure).
In this largest series of PE patients with RHT, use of reperfusion therapy was not associated with significantly lower mortality rates. Additional studies are required to identify effective treatments for this high-risk clinical subgroup.
Sunday, March 29, 2020, 9:17 a.m.-9:27 a.m.
Session Title: Highlighted Original Research: Vascular Medicine and the Year in Review
Abstract Category: 41. Vascular Medicine: Venous Disease
Presentation Number: 906-14
- 2020 American College of Cardiology Foundation