MECHANICAL THROMBECTOMY DURING PULMONARY EMBOLISM: A NATIONAL PERSPECTIVE

Abstract

TOPIC: Procedures TYPE: Original Investigations PURPOSE: The hemodynamic compromise triggered by acute Pulmonary Embolism (PE) is directly responsible for 5-10% of in-hospital deaths. Conventionally, patients suffering from acute massive and acute submissive PE are treated with intravenous or catheter-directed thrombolysis as an early or first line treatment for clot debulking. The use of surgical embolectomy, which is traditionally considered the alternative treatment, has dwindled in clinical practice. The recent technical and clinical success of the percutaneous Mechanical Thrombectomy (MT) makes it a promising treatment strategy. In this study we sought to delineate the utilization trends and clinical outcomes of MT in acute PE using a nationally representative sample. METHODS: National Inpatient Sample (NIS) by Healthcare Cost and Utilization Project for the years 2016-2018 were used to identify adult hospitalizations due to acute PE by using International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM). MT as well as other concurrent diagnosis and comorbidities were identified by previously validated ICD-9/10-CM procedures and diagnosis codes. Our primary objective was to delineate utilization trends and outcomes of MT in acute PE. Cochran Armitage trend test and survey logistic regression were used to analyze the data using SAS 9.4 software. RESULTS: Out of total 561,605 adult hospitalizations due to acute PE from 2016-2018, 4,115 (0.7%) patients underwent MT. Utilization trend increased from 1,125 (0.6%) in 2016 to 1,655 (0.9%) procedure (ptrend:<0.001). Among the acute PE patients who underwent MT, 48.1% were age >65, 52.0% were male and 70.8% were Caucasians. Saddle PE was present among 41.7% acute PE patients who received MT. In-hospital mortality was 10.7% and 21.5% discharged to facilities. In trend analysis, in-hospital mortality remained stable (10.2 % in 2016 to 11.1% in 2018; ptrend:0.15) while discharge to facilities declined (25.1% in 2016 to 21.2 % in 2018; ptrend:<0.01). Furthermore, 15% required mechanical ventilation and only 0.9% patients developed postprocedural Intra cerebral hemorrhage. CONCLUSIONS: In this nationally representative study, we found increasing trends for utilization of MT during acute PE. We also delineated post-procedural outcomes and noted mild improvement in some. CLINICAL IMPLICATIONS: Our study highlights the epidemiological trends and outcomes of 4,115 MT procedures utilized for thrombectomy during hospitalization due to acute PE. DISCLOSURES: No relevant relationships by Sulee Alcacoas, source=Web Response No relevant relationships by apurwa karki, source=Web Response No relevant relationships by Achint Patel, source=Web Response No relevant relationships by Pooja Patel, source=Web Response No relevant relationships by Harshil Shah, source=Web Response No relevant relationships by Csaba Sipos, source=Web Response No relevant relationships by Shrujal Varma, source=Web Response No relevant relationships by Vivek Joseph Varughese, source=Web Response