TY - JOUR
T1 - Contemporary Management and Outcomes of Patients with Massive and Submassive Pulmonary Embolism
AU - Secemsky, Eric
AU - Chang, Yuchiao
AU - Jain, C. Charles
AU - Beckman, Joshua A.
AU - Giri, Jay
AU - Jaff, Michael R.
AU - Rosenfield, Kenneth
AU - Rosovsky, Rachel
AU - Kabrhel, Christopher
AU - Weinberg, Ido
N1 - Funding Information:
Conflict of Interest: JAB is a consultant for Aralez, Astra Zeneca, Janssen, Sanofi, and BMS (modest); serves on the data safety and monitoring board for Bayer (modest); and has equity in EMX and Janacare (modest). JG is a board member of VIVA Physicians, a 501c3 not-for-profit education and research organization (modest). MRJ is a compensated advisor for Philips/Volcano and Venarum (modest), and an equity investor for Embolitech, Vascular Therapies, PQ Bypass, MC10, Jana Care, and Sano V (modest). CK has received grant funding (paid to his institution) from the National Institutes of Health, Janssen, Diagnostica Stago, Siemens Healthcare Diagnostics, and Boehringer-Ingelheim. KR is a consultant for Abbott Vascular, Cardinal Health, Cook, Thrombolex, Surmodics, Volcano/Philips, Amegen; is a consultant on the scientific advisory board with equity or stock options from Capture Vascular, Contego, Cruzar Systems, Endospan, Eximo, MD Insider, Micell, Shockwave, Silkroad Medical, Valcare, Thrombolex; has received equity or stock options for serving on advisory boards from PQ Bypass, Primacea, Capture Vascular, VORTEX, MD Insider, Micell, Shockwave, Cruzar Systems, Endospan, Eximo, Valcare, Contego (modest); has received research grant support to his institution from Atrium-Getinge, Inari Medical, National Institutes of Health, Lutonix-Bard (modest); and is a board member of the National PERT Consortium, a 501c3 non-for-profit education and research organization, and VIVA Physicians, a 501c3 not-for-profit education and research organization (modest). IW is on the scientific advisory board for Novate Medical. All other authors have no relevant disclosures.
Publisher Copyright:
© 2018
PY - 2018/12
Y1 - 2018/12
N2 - Background: Few contemporary studies have assessed the management and outcomes of patients with massive and submassive pulmonary embolism. Given advances in therapy, we report contemporary practice patterns and event rates among these patients. Methods: We analyzed a prospective database of patients with massive and submassive pulmonary embolism. We report clinical characteristics, therapies, and outcomes stratified by pulmonary embolism type. Treatment escalation beyond systemic anticoagulation was defined as advanced therapy. Cox proportional hazards regression was used to identify predictors of 90-day mortality. Results: Among 338 patients, 46 (13.6%) presented with massive and 292 (86.4%) with submassive pulmonary embolism. The average age was 63 ± 15 years, 49.9% were female, 32.0% had malignancy, and 21.9% had recent surgery. Massive pulmonary embolism patients received advanced therapy in 71.7% (30.4% systemic thrombolysis, 17.4% catheter-directed thrombolysis, 15.2% surgical embolectomy) and had greater 90-day mortality rates compared with submassive pulmonary embolism patients (41.3% vs 12.3%, respectively; P <.01). Most massive pulmonary embolism deaths (78.9%) occurred in-hospital, whereas mortality risk persisted after discharge for submassive pulmonary embolism. After multivariable adjustment, massive pulmonary embolism was associated with a 5.23-fold greater hazard of mortality (95% confidence interval, 2.70-10.13; P <.01). Advanced therapies among all pulmonary embolism patients were associated with a 61% reduction in mortality (95% confidence interval, 0.20-0.76; P <.01). Conclusions: Among contemporary massive and submassive pulmonary embolism patients, mortality remains substantial. Advanced therapies were frequently utilized and independently associated with lower mortality. Further investigation is needed to determine how to improve outcomes among these high-risk patients, including the optimal use of advanced therapies.
AB - Background: Few contemporary studies have assessed the management and outcomes of patients with massive and submassive pulmonary embolism. Given advances in therapy, we report contemporary practice patterns and event rates among these patients. Methods: We analyzed a prospective database of patients with massive and submassive pulmonary embolism. We report clinical characteristics, therapies, and outcomes stratified by pulmonary embolism type. Treatment escalation beyond systemic anticoagulation was defined as advanced therapy. Cox proportional hazards regression was used to identify predictors of 90-day mortality. Results: Among 338 patients, 46 (13.6%) presented with massive and 292 (86.4%) with submassive pulmonary embolism. The average age was 63 ± 15 years, 49.9% were female, 32.0% had malignancy, and 21.9% had recent surgery. Massive pulmonary embolism patients received advanced therapy in 71.7% (30.4% systemic thrombolysis, 17.4% catheter-directed thrombolysis, 15.2% surgical embolectomy) and had greater 90-day mortality rates compared with submassive pulmonary embolism patients (41.3% vs 12.3%, respectively; P <.01). Most massive pulmonary embolism deaths (78.9%) occurred in-hospital, whereas mortality risk persisted after discharge for submassive pulmonary embolism. After multivariable adjustment, massive pulmonary embolism was associated with a 5.23-fold greater hazard of mortality (95% confidence interval, 2.70-10.13; P <.01). Advanced therapies among all pulmonary embolism patients were associated with a 61% reduction in mortality (95% confidence interval, 0.20-0.76; P <.01). Conclusions: Among contemporary massive and submassive pulmonary embolism patients, mortality remains substantial. Advanced therapies were frequently utilized and independently associated with lower mortality. Further investigation is needed to determine how to improve outcomes among these high-risk patients, including the optimal use of advanced therapies.
KW - Bleeding
KW - Massive
KW - Mortality
KW - Outcomes
KW - Pulmonary embolism
KW - Readmission
KW - Submassive
UR - http://www.scopus.com/inward/record.url?scp=85052819820&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85052819820&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2018.07.035
DO - 10.1016/j.amjmed.2018.07.035
M3 - Article
C2 - 30102908
AN - SCOPUS:85052819820
SN - 0002-9343
VL - 131
SP - 1506-1514.e0
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 12
ER -