Abstract 1139: Recent Trends And Predictors Of Poor Outcomes In Patients With Chronic Thromboembolic Pulmonary Hypertension Undergoing Pulmonary Artery Thromboendarterectomy.

Abstract

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) occurs due to pulmonary artery obstruction from persistent thromboembolic disease. Pulmonary artery thromboendarterectomy (PTE) is the definitive treatment. In this study, we examine the recent trends, predictors of mortality among patients with CTEPH undergoing PTE. Methods: Using the International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM) diagnosis and procedure codes, we queried the National Inpatient Sample 2016 to 2020 for hospitalizations among patients ≥18 years old with a diagnosis of CTEPH who underwent PTE. We examined the recent trends in the uptake of PTE, the difference in mortality by year, race, sex, and US region. Logistic regression was used to identify independent predictors of mortality among this cohort of patients. Results: Our study included 18,195 hospitalizations with CTEPH of which 1,790 (9.8%) (mean [SD] age: 54.0 [14.9] years) underwent PTE. In this cohort, 51.7% were males and 47.3% were females. We observed an increasing trend in the uptake of PTE; 7.3%, 27.1%, and 37.4% for the years 2017, 2018, 2019 respectively. This trend reversed in 2020 (28.2%) ( p=0.9 ). Mortality was recorded among 5.9% of patients with CTEPH who had PTE. No difference in mortality was observed by sex/gender, year, race, or hospital region. ECMO was utilized among 8.4% of patients with CTEPH undergoing PTE. Mortality was higher among those who utilized ECMO compared to those who did not utilize ECMO (36.7% vs. 3.1%, p<0.0001). ECMO utilization was identified as an independent predictor of mortality OR: 18.4, 6.96-48.74, P<0.0001. Sex, HTN, and Obesity were not associated with mortality in this cohort. Conclusion: We observe increasing utilization of pulmonary artery thromboendarterectomy among patients hospitalized with CTEPH and increased mortality among those requiring ECMO. Further research is needed to identify predictors of poor outcomes among patients with CTEPH undergoing PTE.