Catheter-directed treatment for acute pulmonary embolism: Systematic review and single-arm meta-analyses. (15th December 2016)

• Record Type: Journal Article
• Authors: Bajaj, Navkaranbir S.; Kalra, Rajat; Arora, Pankaj; Ather, Sameer; Guichard, Jason L.; Lancaster, W. Jake; Patel, Nirav; Raman, Fabio; Arora, Garima; Al Solaiman, Firas; Clark, D. Trey; Dell'Italia, Louis J.; Leesar, Massoud A.; Davies, James E.; McGiffin, David C.; Ahmed, Mustafa I.
• Is Part Of: International journal of cardiology. Volume 225(2016)
• Page Start: 128
• Page End: 139
• Publication Date: 2016-12-15
• Subjects: AT aspiration thrombectomy -- CDT catheter-directed treatment -- HI haemodynamic instability -- HS haemodynamic stability -- IT intrapulmonary thrombolysis -- MF mechanical fragmentation -- mmHg millimetres of mercury -- mPAP mean pulmonary artery pressure -- PE pulmonary embolism -- RT rheolytic thrombectomy -- Unstable haemodynamic status studies where all patients had acute pulmonary embolism causing right ventricular dysfunction and haemodynamic instability. -- Stable and unstable haemodynamic status studies where all patients had acute pulmonary embolism and right ventricular dysfunction but outcomes were not stratified according to haemodynamic stability. -- Stable haemodynamic status studies where all patients had acute pulmonary embolism causing right ventricular dysfunction but remained haemodynamically stable. -- USAT ultrasound-accelerated thrombolysis; Pulmonary embolism -- Thrombolysis -- Catheter-directed treatment; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.09.036
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: We sought to estimate the efficacy and safety outcomes of catheter-directed treatment (CDT) for patients with acute pulmonary embolism (PE). Methods: We searched SCOPUS for studies reporting outcomes after CDT for acute PE. Studies were categorized in three groups for analyses due to heterogeneity in the classification of acute PE: 1) patients with PE causing right ventricular dysfunction and haemodynamic instability: unstable haemodynamic status, 2) patients with PE causing right ventricular dysfunction where study outcomes were not stratified by haemodynamic status: stable and unstable haemodynamic status, and 3) patients with PE causing right ventricular dysfunction who remained haemodynamically stable: stable haemodynamic status. Efficacy and safety outcomes were estimated and presented as point estimates with 95% confidence intervals. Results: In 35 studies with 1253 patients, 1277 CDTs were performed. The in-hospital mortality rates for the unstable haemodynamic status, stable and unstable haemodynamic status, and stable haemodynamic status groups were 18.1% (7.3–38.2%), 7.1% (5.0–10.1%), and 2.6% (0.8–7.3%), respectively. The major bleeding rates across the groups were estimated to be 4.5, 8.5 and 3.9 per 100 CDTs, respectively. Minor bleeding occurred in 6.2, 11.9 and 9.1 per 100 CDTs, respectively. After CDT, all groups had improvements in mean pulmonary artery pressure and right ventricular function. Conclusions: We provide descriptive measures of efficacy and safety for patients who underwent CDT for acute PE.