Results of the treatment of pulmonary embolism

DATA FROM REGISTRIES

ZBIGNIEW GĄSIORKATEDRA i KLINIKA KARDIOLOGII SUM Katowice

Session: Pulmonary embolism – new therapeutic optionsPeripheral Interventions in Krakow

8-9.05.2014

No conflict of interest in relation to this presentation

Massive PE SBP <90mmHg n=58

Nonmassive PE SBP >90mmHg n=1817

Anticoagulation 57 (98%) 1790 (98%)

Fibrinolysis 7 (12%) 43 (2%)

Embolectomy 2 (3,4%) -surgical 13 (0,75) – surg.5, cath 8

IVC filter 9 (15%) 273 (15%)

Outcome measures of pts with and without Massive PE

Massive PE SBP <90mmHg n=58

Nonmassive PE SBP >90mmHg n=1817

P

In-patient outcomeMortalityDeath from PEBleeding complications

8 (14%)3 (5%)6 (10%)

54 (3%)16 (0,9%)63 (3,5%)

<0.001<0.02<0.01

30-d outcomeMortalityBleeding complications

n=507 (14%)1 (2%)

n=176332 (2%)23 (1,3%)

<0.01NS

Brian W

1716 pts from 47 hospitals age 70+15 years17% hemodynamically unstable

Treatment:Thrombolytic agents in 185 (10,8%)Percutaneous thrombectomy in 14 (0,8%)Surgery in 2 (0,1%)116 (6,7%) in-hospital deathsDeath or clinical deterioration in 138 (8,0%)

Overall mortality of pulmonary embolectomy 18,8%

ZATPOL

Polish National Registry on

Pulmonary Embolism

Aim:

To assess whether adherence to validated diagnostic criteria affects survival of patients with suspected pulmonary

embolism

Material

0

400

800

1200

1600

2000

I 200

7

II 20

07

III 2

007

IV 2

007

V 2

007

VI 2

007

VII

2007

VIII

200

7

IX 2

007

X 2

007

XI 2

007

XII

2007

I 200

8

II 20

08

III20

08

IV 2

008

V 2

008

VI 2

008

VII

2008

VIII

200

8

IX 2

008

Accepted questionnaires

-2015 patients (40% males, mean age 65 ± 15yrs)

- 80 departments of cardiology in Poland with clinical suspicion of PE

- JAN 2007 – SEP 2008

- 90 days follow-up mortality data available for 1537 (76%) patients

nn = 2015

All-cause mortality

0%

10%

20%

30%

in-hospital mortality(n=2015) 90 days follow-up mortality (n=1537)

PE confirmed ureliable diagnosis PE excluded

p<0.001

p<0.001

7.0% 14.3% 5.0% 15.6% 1 1.5%27.3%

Factors related to all-cause in-hospital mortality

OR 95% CI p

Unreliable diagnosis of PE 2.26 1.52 – 3.36 <0.0001

Symptoms of high-risk PE 9.29 6.49 – 13.3 <0.001

Local positive diagnosis of PE 1.14 0.76 – 1.72 0.51

Age > 75 years 1.74 1.21 – 2.51 0.003

Low clinical probability 0.18 0.06 – 0.51 0.001

Lung disease with respiratory failure 0.98 0.53-1.43 0.95

CHF – NYHA III-IV 1.56 1.04 – 2.32 0.03

ZATPOL – high-risk PE treatment

Locally confirmed high-risk PEn=229

deaths n=68mortality = 30%

Thrombolytic therapyn=89

deaths n= 35mortality = 39%

No Thrombolytic therapyn=140

deaths n=33mortality =24%

ZATPOL – high-risk PE treatment

Thrombolytic therapy introduction

clinical picture - 26 (29%)

clinical picture + ECHO - 34 (38%)

clinical picture + angioCT/arteriography – 29 (33%)

rtPA 100mg/2h

rtPA 50mg/15min

STK 1.5mln j/1-2h

STK 250tys j/h 100tys j/h

76%

ZATPOL - high-risk PE treatment

No Thrombolytictreatment

n = 140

Thrombolytictreatment

n = 89p

Intracranialhaemorrage

0 3 (3.4%) 0.03

Allhaemorrhages

10 (7.1%) 22 (24.7%) <0.001

Haemorrhagic complications

Intracranial haemorrhages leading to death 1.8%

ZATPOL – high-risk PE other treatment methods

• Surgical PULMONARY EMBOLECTOMY - 11 pts

- PE (+) in imaging methods (n=10)

- thrombus in right heart in ECHO (n=1)

- 1 periprocedural death

• Interventional EMBOLECTOMY

- thrombus fragmentation using pig-tail catheter– 3 pts

- 1 death after procedure

• IVC Filter – 3 pts

SEATTLE-II Trial ACC Washington 2014A New Era for Massive and Submassive PE

150 pts (31 massive PE, 119 submassive PE)Ultrasound-facilitated catheter-directed low-dose thrombolysis

24 mg tPA 1mg/h for 24 hoursRESULTS:

1 death attributed to PENo deaths in massive PE within 30 days follow-up

No intracranial hemorrhages

THANK YOU

Results

2015 patients with suspected PE

Locally confirmed

PE

Locally excluded

PE

p

Prevalence 1316 (65%) 699 (35%)

Reliable diagnosis 84% 71% <0.001

Diagnostic process

adhered to ESC

Guidelines

76% 66% 0.003

Reliable diagnosis :

79,9% (95%CI: 78.2 – 81.6 %)