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. 2022 Jun 16:9:861307.
doi: 10.3389/fcvm.2022.861307. eCollection 2022.

Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients

Arkadiusz Pietrasik  1 , Aleksandra Gąsecka  1 , Łukasz Szarpak  2   3 , Michał Pruc  4 , Tomasz Kopiec  1 , Szymon Darocha  5 , Marta Banaszkiewicz  5 , Maciej Niewada  6 , Marcin Grabowski  1 , Marcin Kurzyna  5
Affiliations

Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients

Arkadiusz Pietrasik et al. Front Cardiovasc Med. .

Abstract

Background: Catheter-directed therapies (CDT) are an alternative to systemic thrombolysis (ST) in pulmonary embolism (PE) patients, but the mortality benefit of CDT is unclear.

Objective: We conducted a systematic review with meta-analysis to compare the efficacy and safety of CDT and ST in intermediate-high and high-risk PE.

Methods: We included (P) participants, adult PE patients; (I) intervention, CDT; (C) comparison, ST; (O) outcomes, mortality, complications, in-hospital treatment, and length of hospital stay; (S) study design, randomized controlled trials (RCTs), or cohort comparing CDT and ST. The primary endpoint was 30-day mortality. Secondary outcomes included treatment-related complications including bleeding, the use of hospital resources, and length of hospital stay.

Results: Eleven studies including 65,589 patients met the inclusion criteria. Thirty-day mortality was lower in the CDT group, compared to ST group [7.3 vs. 13.6%; odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.38-0.69, p < 0.001]. The rates of myocardial injury, cardiac arrest, and stroke were lower in CDT group, compared to ST group (p < 0.001 for all). The rates of any major bleeding, intracranial hemorrhage, hemoptysis, and red blood cell transfusion were lower in patients treated with CDT, compared to ST (p ≤ 0.01 for all). Extracorporeal life support was used more often in patients treated with CDT, compared to ST (0.5 vs. 0.2%, OR = 2.52, 95% CI 1.88-3.39, p < 0.001). The use of hospital resources and length of hospital stay were comparable in both groups.

Conclusion: CDT might decrease mortality in patients with intermediate-high and high-risk PE and were associated with fewer complications, including major bleeding.

Keywords: PERT; catheter-based therapies; meta-analysis; pulmonary embolism; pulmonary embolism response team.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram showing the stages of database searching and study selection according to the PRISMA guidelines.
FIGURE 2
FIGURE 2
Forest plot of length of hospital stay in the catheter-directed therapies (CDT) group and systemic thrombolysis (ST). Each green rectangle or square represents an individual study, with 95% confidence intervals of the result displayed as black horizontal lines. The diamonds show the result when all the individual studies are combined together and averaged.
See this image and copyright information in PMC

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