Abstract Number: PB2473
Meeting: ISTH 2020 Congress
Background: Reperfusion therapy (RTh) in stable patients with intermediate risk acute pulmonary embolism (PE) and right ventricular (RV) dilatation is not recommended in guidelines. Patients with RV dilatation and reduced tricuspid annular plane systolic excursion (TAPSE) or RV wall motion abnormalities may carry a worse prognosis. Insufficient evidence exists about the benefit of RTh in this population.
Aims: Establish the benefit of RTh in terms of in-hospital mortality (IHM) in patients with intermediate risk PE with RV dysfunction (RVD) defined as RV dilatation and concomitant reduced TAPSE or RV wall motion abnormalities.
Methods: Single-center observational cohort registry performed at a University Hospital in Argentina. Patients hospitalized with a diagnosis of PE and RVD between 2008-2018 were eligible. RV diameter, TAPSE, and wall motion abnormalities were determined by echocardiography. We also collected information related to clinical presentation, PESI score, troponin levels and electrocardiographic pattern. We compared the IHM of patients who received RTh versus those treated with a conservative approach (no-RTh). Patients with surgical thrombectomy were excluded. All statistical analysis was carried out using the STATA version 13.1.
Results: 230 consecutive patients were hospitalized with a diagnosis of PE. 45 patients with RVD were included. Mean age 64±16 years; 54,6% female. Global IHM in patients with RVD was 10.7%. Univariate analysis showed that the RTh group had a higher proportion of males (57.6 vs 26.3%; p:0.03) and more dyspnea (100 vs 84.2%; p:0.03). Clinical characteristics of both groups are shown in the table. After multivariate logistic regression analysis, the IHM of patients who received RTh did not differ from those in the no-RTh group (11.5 vs 15.7%; p:ns).
Conclusions: In this cohort of patients with intermediate-risk PE and RVD, reperfusion therapy did not correlate with lower IHM.
|Age (mean)||62 (±19)||68 (±13)||ns|
|Male||15 (57.6%)||5 (26.3%)||0.03|
|Dyspnea||26 (100%)||16 (84.2%)||0.03|
|Syncope||4 (15.3%)||1 (5.2%)||ns|
|Systolic blood pressure (mmHg)||119 (SD 24)||124 (SD 22)||ns|
|Sinus tachycardia (bpm)||19 (73%)||12 (63.1%)||ns|
|Right bundle branch block||3 (11.5%)||5 (26.3%)||ns|
|Elevated troponin levels||22 (84.6%)||11 (57.8%)||ns|
|in-hospital mortality||3 (11.5%)||3 (15.7%)||ns|
[Reperfusion therapy (RTh) vs. conservative approach (no-RTh). Clinical characteristics and in-hospital mortality.]
To cite this abstract in AMA style:Bilbao J, Bonorino J, Horacio F, Ferrario C, Torres N, Iwanowski M, Melchiori R, Alarcon P, Santucci J, Conde Blanco M, Ortis E, Aris Cancela ME, Della Cella R, Krause S, Sanchez A, Perez Caceres N, Marquez S, Rubio P, Hita A, Baratta S. Correlation of Reperfusion Therapy and In-hospital Mortality in Patients with Intermediate Risk Acute Pulmonary Embolism and Right Ventricular Dysfunction [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/correlation-of-reperfusion-therapy-and-in-hospital-mortality-in-patients-with-intermediate-risk-acute-pulmonary-embolism-and-right-ventricular-dysfunction/. Accessed September 29, 2023.
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