Key result
Surgical embolectomy is linked to ~59% fewer residual emboli than thrombolysis despite similar high-risk PE mortality.
Why the study?
Does surgical embolectomy improve morbidity and mortality compared to thrombolysis in patients with acute high- and intermediate-risk pulmonary embolism?
Cohort (n=136)
Does surgical embolectomy improve morbidity and mortality compared to thrombolysis in patients with acute high- and intermediate-risk pulmonary embolism?
p-value: p=0.16
Surgical embolectomy for acute high-risk pulmonary embolism yields similar mortality to thrombolysis but significantly improves long-term pulmonary endpoints such as residual emboli and diffusion impairment.
Surgical embolectomy was associated with similar mortality and fewer residual emboli than thrombolysis in high-risk PE; leaves open superiority without randomized confirmation.
OBJECTIVES: The aim of this study was to investigate the long-term outcome after acute high- and intermediate-risk pulmonary embolism (PE) treated with surgical embolectomy or thrombolysis. METHODS: Prospective follow-up including assessment of 30-day and 5-year mortality. Clinical evaluation including ventilation/perfusion scintigraphy by single-photon emission computed tomography in combination with X-ray computed tomography, measurement of pulmonary diffusion impairment, spirometry and echocardiography. RESULTS: A total of 136 patients (64 with high-risk and 72 with intermediate-risk PE) were included, 80 participated in the clinical follow-up, 16 were alive but declined follow-up and 40 were deceased. For high-risk PE patients the median time to clinical follow-up was 31 months [8–133]. No significant difference was observed in 30-day (Plog-rank = 0.16) or 5-year (Plog-rank = 0.53) mortality between patients treated with surgical embolectomy or thrombolysis. Ventilation/perfusion mismatch identified residual emboli in 4 patients (31%) treated with surgical embolectomy compared to 16 (76%) treated with thrombolysis (P = 0.009). Pulmonary diffusion impairment was identified in 4 patients (31%) treated with surgical embolectomy in comparison to 15 (71%) treated with thrombolysis (P = 0.02). In intermediate-risk PE patients, no significant difference in mortality (Plog-rank = 0.51 and 0.86), diffusion impairment or ventilation/perfusion mismatch was found between patients treated with surgical embolectomy or thrombolysis. CONCLUSIONS: Surgical embolectomy for acute high-risk PE has similar mortality, but better outcome on pulmonary end-points when compared to thrombolysis. Patients with high-risk PE could benefit from being referred to a centre with both specialized cardiology and cardiothoracic surgery for interdisciplinary evaluation of optimal treatment strategy.
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Lehnert et al. (2016) conducted a cohort in Acute high- and intermediate-risk pulmonary embolism (n=136). Surgical embolectomy vs. Thrombolysis was evaluated on 30-day and 5-year mortality (p=0.16). Surgical embolectomy for acute high-risk pulmonary embolism had similar mortality to thrombolysis but resulted in fewer residual emboli (31% vs 76%, P=0.009).
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