Abstract 14895: Catheter-Based Treatment for Pulmonary Embolism With Concomitant Use of Intrapulmonary Thrombolysis Improves In-Hospital Mortality Rates

Abstract

Introduction: In-hospital mortality rates after catheter-based treatment (CBT) of high-risk pulmonary embolism (PE) are variable. Use of intrapulmonary thrombolytics with other CBT may result in rapid clearance of obstruction, prevent extremis and lead to improved mortality rates. Hypothesis: We hypothesized that the concomitant use of intrapulmonary thrombolysis in conjunction with CBT may affect mortality and explain the heterogeneity among in-hospital mortality rates. Methods: We searched SCOPUS since inception to November 2014 using predefined criteria. Studies reporting in-hospital mortality in patients with massive PE or a combination of massive and submassive PE, as defined by the American Heart Association, were included. In-hospital all-cause mortality rates were estimated in these high-risk patients using standard meta-analytic methods. Heterogeneity in mortality rates was explored with meta-regression. Results: In 54 eligible studies with 1,333 patients, 1357 CBT procedures were performed. All CBT modalities were studied. In-hospital mortality rates varied widely amongst studies (Figure, Panel A). On meta-regression with Logit-in hospital mortality rate as the dependent variable, studies that had a higher proportion of patients who received concomitant intrapulmonary thrombolysis had lower Logit in-hospital mortality rate (β = - 0.01, p <0.001; Figure, Panel B). Conclusions: Concomitant use of intrapulmonary thrombolytics is associated with lower in-hospital mortality rate in patients undergoing CBT for high-risk PE.