Among patients with acute PE managed by PERT, higher ESC risk class (IRR 0.153; p<0.001) and need for systemic thrombolysis (IRR 0.332; p=0.012) were associated with shorter time-to-intervention.
Observational (n=62)
Yes
What factors are associated with the time-to-intervention for advanced reperfusion therapy in patients with acute pulmonary embolism managed by PERT?
Higher ESC risk class and the need for systemic thrombolysis are associated with a shorter time to advanced reperfusion therapy in patients with acute pulmonary embolism.
Effect estimate: IRR 0.153
p-value: p=<0.001
Abstract Rationale Acute pulmonary embolism (PE) is the third most common acute cardiovascular disease with a 30-day mortality rate of as high as 30% in high-risk cases. Advanced reperfusion therapies (ART) for acute PE have recently gained popularity at PE centers of excellence and include catheter-directed thrombolysis (CDT) and mechanical thrombectomy. While ART have been associated with improved outcomes, the timing of ART remains unexplored. In the present study, we analyzed factors associated with timing of ART in patients with acute PE managed by PERT who received ART. Methods A retrospective chart review of all patients with acute PE managed by PERT and undergoing ART at one of three urban teaching hospitals within the Mount Sinai Health System from January 2021 to September 2023 was performed. Data pertaining to demographics, PE severity, clinical features, laboratory investigations, radiologic studies and echocardiography were systematically recorded. Time-to-intervention (TTI) was defined as the time interval between diagnosis of acute PE and initiation of ART. Negative binomial regression was used to model factors associated with TTI within the patient cohort and incidence rate ratios (IRR) were calculated. A p-value of less than 0.05 was considered statistically significant. Results A total of 62 patients with a median age of 60 (IQR: 51‒71) years (n = 26, 41.9% female) were included. ART administered to patients were CDT and pulmonary mechanical thrombectomy in 18 (29.0%) and 44 (71.0%) cases respectively. Median PESI score was 72 (IQR: 62‒91) points. Based on ESC risk stratification, 9 (14.5%), 49 (79.0%) and 4 (6.4%) had intermediate low-, intermediate high- and high-risk acute PE. ART administered to patients included CDT and mechanical thrombectomy in 29.0% (n = 18) and 71.0% (n = 44) of cases respectively. Median TTI for included patients was 15.1 (IQR: 9.7‒25.3) hours. In the multivariable negative binomial regression model, need for systemic thrombolysis (IRR: 0.332; p=0.012) and higher ESC risk class (IRR: 0.153; p0.001) were associated with shorter TTI. Conclusion Among patients with acute PE managed by PERT and requiring ART, linear increments in ESC risk class were associated with shorter TTI. Likewise, need for systemic thrombolysis was associated with shorter TTI. This abstract is funded by: none
Sheikh et al. (Fri,) conducted a observational in Acute pulmonary embolism (PE) (n=62). Advanced reperfusion therapy (ART) was evaluated on Time-to-intervention (TTI) (IRR 0.153, p=<0.001). Among patients with acute PE managed by PERT, higher ESC risk class (IRR 0.153; p<0.001) and need for systemic thrombolysis (IRR 0.332; p=0.012) were associated with shorter time-to-intervention.