F-30 | Trends in Percutaneous Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Percutaneous Balloon Pulmonary Angioplasty (PBPA) is a potential treatment option for patients with inoperable Chronic Thromboembolic Pulmonary Hypertension (CTEPH). While newer, more effective techniques are associated with lower rates of morbidity and mortality, there is a lack of data on real-world clinical usage patterns. This study aims to investigate contemporary trends, patient characteristics, and in-hospital mortality rates of patients undergoing PBPA. We conducted a retrospective study using the National Inpatient Sample Database from 2016 to 2020. We identified all adults who underwent PBPA for CTEPH using ICD-10 codes. We investigated patient demographics, trends in the number of procedures performed, and in-hospital mortality rates. From 2016 through 2020, 1,600 PBPA procedures were performed for CTEPH. There was no significant change in the number of procedures performed annually (p for trend 0.728). The in-hospital mortality rate was 5.31% during this time period, which remained unchanged (p for trend 0.42). However, over time, procedures were increasingly performed on patients with a higher comorbidity burden, as represented by the Elixhauser Comorbidity Index (3.05 in 2016 to 4.18 in 2020, p for trend 0.001). The predictors of in-hospital mortality were hospital bed size (OR 0.47, 95% CI 0.23-0.94), location/teaching status of the hospital (0.21, 95% CI 0.06-0.65), elective procedure (0.13, 95% CI 0.03-0.63), and Charlson comorbidity index (1.69, 95% CI 1.16-2.47). Despite the introduction of new, effective techniques, the adoption of PBPA did not increase over the studied 5-year time frame. Large, urban teaching hospitals, elective procedures, and fewer patient comorbidities predicted lower in-hospital mortality. This suggests a need for further research to optimize patient selection, procedural settings, and strategies.