Thrombolysis For Pulmonary Embolism Research Articles

Effectiveness and safety of half-dose thrombolysis in intermediate-high risk pulmonary embolism: a single centre experience

Abstract Funding Acknowledgements None. Introduction According to current guidelines, full-dose systemic thrombolysis for pulmonary embolism (PE) is limited to patients either classified as high risk or presenting intermediate risk with hemodynamically instability. As evidenced by recent clinical trials, "low" half-dose (50 mg) tissue plasminogen activator (HDrtPA) appears to offer a safe, effective alternative with a low bleeding risk, especially if catheter directed therapies are not available. Purpose we aimed to evaluate if HDrtPA in intermediate-high risk PE could improve right ventricular (RV)-arterial coupling by means of TAPSE/PAPs ratio, right ventricular basal dimensions in 4 chambers (RVD1), and tricuspid velocity (TV) between admission and discharge, exploring eventual associated bleeding risk. Methods we retrospectively analized 90 intermediate-high risk PE patients consecutively admitted to our intensive cardiac care unit between January 2016 and May 2023. Diagnosis was achieved by computed tomography in all cases. All patients underwent echocardiographic assessment upon admission and at discharge along with baseline lab values. HDrtPA patients (Group A, n=28) received low-dose thrombolytic therapy (0,6 mg/kg maximum 50 mg in 1 hour) combined with unfractionated heparin. Standard anticoagulation patients (Group B) included patients exclusively treated with parenteral anticoagulants. Primary endpoint was echocardiographic improvement of RV-arterial coupling (TAPSE/PAPS), and of pulmonary pressures (tricuspid velocity, TV) and right ventricular basal dimension (RVD1) between admission and dis-charge in the two treatment arms. To perform this analysis, linear regression models with Inverse Probability Weighting (IPW) propensity scores were used. Secondary endpoint was presence of mayor or minor bleeding between groups, and a descriptive analysis of mortality due to paucity of events. Results in the whole population mean age was 73.48 ± 12.49 (mean ± sd) and n=43 (47.8%) were males. Between admission and discharge, group A (HDrtPA) had an improvement of TAPSE/PAPs (+0.16, p=0.05, CI 95%: -0.002; 0.325), of RVD1 (-6.00 mm, p <0.01, CI 95%: -2.59; 9.41). Reduction of TV values (-0.45 m/s, p=0.108, CI 95%: -1.02; 0.10) was not statistically significant at IPW propensity score, but deserves further investigations. No significant increase of major bleedings were recorded between two groups (Group A: 1/28 3.5%, Group B: 0/52 0%) with an acceptable number of minor, non fatal bleedings (Group A: 7/28: 25%, Group B 1/62 1.6%). Death occurred in 3 patients in group A (10%) and 1 patient in group B (1.6%). Conclusion half dose of tissue plasminogen activator (HDrtPA) offer a promising alternative to anticoagulation alone therapy in selected patients with high-intermediate risk pulmonary embolism. In our experience, this approach seems to acutely improve RV-arterial coupling and right ventricular dimensions, without an increase of major bleeding risk.

Accumulating Evidence for Reduced-Dose Thrombolysis in Acute Pulmonary Embolism.

Accumulating Evidence for Reduced-Dose Thrombolysis in Acute Pulmonary Embolism.

F-22 | Clinical Outcomes for Patients with Thrombocytopenia who underwent Catheter-Directed Thrombolysis for Pulmonary Embolism: An Analysis of the National Inpatient Sample

F-22 | Clinical Outcomes for Patients with Thrombocytopenia who underwent Catheter-Directed Thrombolysis for Pulmonary Embolism: An Analysis of the National Inpatient Sample

F-26 | Clinical Outcomes for Patients with Obesity who underwent Catheter-Directed Thrombolysis for Pulmonary Embolism: An Analysis of the National Inpatient Sample

F-26 | Clinical Outcomes for Patients with Obesity who underwent Catheter-Directed Thrombolysis for Pulmonary Embolism: An Analysis of the National Inpatient Sample

F-27 | Clinical Outcomes for Patients with Peripheral Arterial Disease who underwent Catheter-Directed Thrombolysis for Pulmonary Embolism: An Analysis of the National Inpatient Sample

F-27 | Clinical Outcomes for Patients with Peripheral Arterial Disease who underwent Catheter-Directed Thrombolysis for Pulmonary Embolism: An Analysis of the National Inpatient Sample

F-21 | Clinical Outcomes for Catheter-Directed Thrombolysis for Pulmonary Embolism in Octogenarians, Nonagenarians, and Centenarians: A retrospective cohort study

F-21 | Clinical Outcomes for Catheter-Directed Thrombolysis for Pulmonary Embolism in Octogenarians, Nonagenarians, and Centenarians: A retrospective cohort study

OR11-2 | Sex Differences in Outcomes Among Patients who Underwent Catheter-Directed Thrombolysis for Pulmonary Embolism: A Retrospective Cohort Study

OR11-2 | Sex Differences in Outcomes Among Patients who Underwent Catheter-Directed Thrombolysis for Pulmonary Embolism: A Retrospective Cohort Study

Successful thrombolysis for pulmonary embolism during pregnancy

Successful thrombolysis for pulmonary embolism during pregnancy

Ultrasound-Facilitated, Catheter-Directed Thrombolysis for Acute Pulmonary Embolism.

Acute pulmonary embolism (APE) poses a significant risk to patient health, with treatment options varying in efficacy and safety. Ultrasound-facilitated catheter-directed thrombolysis (USCDT) has emerged as a potential alternative to conventional catheter-directed thrombolysis (CDT) for patients with intermediate to high-risk APE. This study aimed to compare the efficacy and safety of USCDT versus conventional CDT in patients with intermediate to high-risk APE. This observational retrospective study was conducted at the Armed Forces Hospital, Al-Hada, Taif, the Kingdom of Saudi Arabia (KSA), on 135 patients diagnosed with APE and treated with either USCDT or CDT (58 underwent CDT, while 77 underwent USCDT). The primary efficacy outcome was the change in the right ventricle to the left ventricle (RV/LV) diameter ratio.Secondary outcomes included changes in pulmonary artery systolic pressure and the Miller angiographic obstruction index score. Safety outcomes focused on major bleeding events. Both USCDT and CDT significantly reduced RV/LV diameter ratio (from 1.35 ± 0.14 to 1.05 ± 0.17, P < 0.001) and systolic pulmonary artery pressure (SPAP) (from 55 ± 7 mmHg to 38 ± 7 mmHg, P < 0.001) at 48- and 12-hours post-procedure, respectively, with no significant differences between treatments. However, USCDT was associated with a significantly lower rate of major bleeding events compared to CDT (0% vs. 3.4%, P = 0.008). Multivariate logistic regression analysis revealed that USCDT was associated with a 71.9% risk reduction of bleeding (OR = 0.281, 95% CI = 0.126 - 0.627, P = 0.002). USCDT is a safe and effective alternative to CDT for the treatment of intermediate to high-risk APE, as it significantly reduces the risk of major bleeding.

Physiologically Guided Thrombolysis in Pulmonary Embolism

We describe the case of a 69-year-old woman who presented with submassive pulmonary embolism without overt shock, but with significant signs of right ventricular failure and dyspnea on minimal exertion. She was managed using a point-of-care ultrasound and pulmonary artery pressure-guided approach in order to minimize total thrombolytic dose while nonetheless achieving significant physiological improvement.

Ultrasound-assisted endovascular thrombolysis versus large-bore thrombectomy in acute intermediate-high risk pulmonary embolism: The propensity-matched EKNARI cohort study.

Ultrasound-assisted thrombolysis (USAT) and large-bore-thrombectomy (LBT) are under investigation for the treatment of intermediate-high and high-risk pulmonary embolisms (PE). Comparative studies investigating both devices are scarce. This study aimed to compare the safety and efficacy of the two most frequently used devices for treatment of acute PE. This multicenter, retrospective study included 125 patients undergoing LBT or USAT for intermediate- or high-risk PE between 2019 and 2023. Nearest neighbor propensity matching with logistic regression was used to achieve balance on potential confounders. The primary outcome was the change in the right to left ventricular (RV/LV) ratio between baseline and 24 h. A total of 125 patients were included. After propensity score matching, 95 patients remained in the sample, of which 69 (73%) underwent USAT and 26 (27%) LBT. The RV/LV ratio decrease between baseline and 24 h was greater in the LBT than in the USAT group (adjusted between-group difference: -0.10, 95% CI: -0.16 to -0.04; p = 0.001). Both procedures were safe and adverse events occurred rarely (10% following USAT vs. 4% following LBT; p = 0.439). In acute intermediate-high and high-risk PE, both LBT and USAT were feasible and safe. The reduction in RV/LV ratio was greater following LBT than USAT. Further randomized controlled trials are needed to confirm these findings.

Abstract No. 177 ▪ Featured Abstract A Comparison of Post-Procedural Hemoglobin in Catheter-Directed Thrombolysis vs. Large-Bore Aspiration Thrombectomy for Acute Pulmonary Embolism

Abstract No. 177 ▪ Featured Abstract A Comparison of Post-Procedural Hemoglobin in Catheter-Directed Thrombolysis vs. Large-Bore Aspiration Thrombectomy for Acute Pulmonary Embolism

Comparison of In-Hospital Outcomes between Early and Late Catheter-Directed Thrombolysis in Acute Pulmonary Embolism: A Retrospective Observational Study.

The purpose of this study is to evaluate whether early initiation of catheter-directed thrombolysis (CDT) in patients presenting with acute pulmonary embolism is associated with improved in-hospital outcomes. A retrospective cohort was extracted from the 2016-2019 National Inpatient Sample database, consisting of 21,730 weighted admissions undergoing CDT acute PE. From the time of admission, the sample was divided into early (<48 h) and late interventions (>48 h). Outcomes were measured using regression analysis and propensity score matching. No significant differences in mortality, cardiac arrest, cardiogenic shock, or intracranial hemorrhage (p > 0.05) were found between the early and late CDT groups. Late CDT patients had a higher likelihood of receiving systemic thrombolysis (3.21 [2.18-4.74], p < 0.01), blood transfusion (1.84 [1.41-2.40], p < 0.01), intubation (1.33 [1.05-1.70], p = 0.02), discharge disposition to care facilities (1.32 [1.14-1.53], p < 0.01). and having acute kidney injury (1.42 [1.25-1.61], p < 0.01). Predictors of late intervention were older age, female sex, non-white ethnicity, non-teaching hospital admission, hospitals with higher bed sizes, and weekend admission (p < 0.01). This study represents a comprehensive evaluation of outcomes associated with the time interval for initiating CDT, revealing reduced morbidity with early intervention. Additionally, it identifies predictors associated with delayed CDT initiation. The broader ramifications of these findings, particularly in relation to hospital resource utilization and health disparities, warrant further exploration.

A decisive lifesaving tool in submassive pulmonary embolism: Bedside echocardiography

Key Clinical MessageImmediate thrombolysis in submassive pulmonary embolism on the basis of bedside echocardiography can be a lifesaving decision in areas where computed tomography (CT) pulmonary angiogram is not readily available.AbstractBedside echocardiography can be a rapid diagnostic and decision‐making tool for immediate thrombolysis in submassive pulmonary embolism with evidence of progressively failing ventricles. We report a case of submassive pulmonary embolism in a 26‐year‐old male under testosterone replacement therapy, who was successfully thrombolyzed based on bedside echocardiography findings.

Fatal Pulmonary Embolism, Fatal Bleeding and Intracranial Hemorrhage with Systemic and Catheter-Directed Thrombolysis in Intermediate-High and High-Risk Pulmonary Embolism: A Systematic Review with Meta-Analysis

Background: Thrombolysis, either systemic (ST) or catheter-directed (CDT), may reduce mortality in patients with intermediate-high and high-risk pulmonary embolism (PE), but with an increased risk of major bleeding (MB). Moreover, uncertainties remain for other efficacy and safety outcomes, such as fatal PE, fatal bleeding, and intracranial hemorrhage (ICH). Aims: To evaluate fatal PE, fatal bleeding and ICH with ST and CDT in patients with intermediate-high and high-risk PE. Methods: We performed a systematic search in MEDLINE, EMBASE and Cochrane from inception to December 2022. Randomized trials and cohort/observational studies of patients with intermediate-high and high-risk PE were included. We report fatal PE, fatal bleeding and ICH; mortality and MB have been previously reported. Pooled proportions with their 95% confidence interval (CI) were calculated for each treatment group. Results: One hundred and fifty-eight studies (87,874 patients) were included. In patients treated with ST, 30-day mortality and MB occurred in 10.4% (95%CI 6.6%-14.8%; I 2=99%) and in 8.0% (95%CI 5.8%-10.5%; I 2=96%), respectively. Fatal PE occurred in 3.9% (95%CI 2.1%-6.3%; I 2=88%), fatal bleeding in 1.7% (95%CI 1.3%-2.3%; I 2=8%) and ICH in 1.6% (95%CI 1.3%-1.9%; I 2=17%). In patients treated with CDT, 30-day mortality and MB occurred in 5.3% (95%CI 3.6%-7.3%; I 2=93%) and in 5.4% (95%CI 3.8%-7.2%; I 2=87%), respectively. Fatal PE occurred in 1.5% (95%CI 1.0%-2.0%; I 2=2%), fatal bleeding in 1.2% (95%CI 0.8%-1.6%; I 2=0%) and ICH in 0.6% (95%CI 0.4%-0.9%; I 2=7%). In patients treated with anticoagulation alone, 30-day mortality and MB occurred in 9.9% (95%CI 7.1%-13.1%; I 2=97%) and in 3.8% (95%CI 2.6%-5.4%; I 2=66%), respectively. Fatal PE occurred in 3.3% (95%CI 1.9%-5.2%; I 2=65%), fatal bleeding in 0.5% (95%CI 0.2%-0.9%; I 2=0%) and ICH in 0.7% (95%CI 0.3%-1.3%; I 2=64%). Conclusion: In patients with intermediate-high and high-risk PE, fatal PE was non-negligeable in all treatment modalities and must be balanced with equally important fatal bleeding event rates. Additional studies are needed to further assess these efficacy and safety parameters of thrombolytics in patients with intermediate-high and high risk PE.

Effectiveness and safety of catheter-directed thrombolysis for pulmonary embolism in key patient subgroups: results of an individual patient level analysis

Abstract Background The effectiveness of catheter-directed thrombolysis (CDT) for acute pulmonary embolism (PE) has been rarely investigated in subgroups of patients at a higher risk of complications. Furthermore, this group of patients has been excluded from prior and ongoing phase 3 trials with CDT. Purpose To assess the efficacy and safety of catheter-directed thrombolysis for pulmonary embolism among specific patient subpopulations. Material and methods We conducted an individual patient-level analysis of patient data from 16 cohort studies and randomized trials of CDT for intermediate- and high-risk acute PE. Studies were identified on the basis of a systematic review of the literature. We focused on early clinical outcomes, including haemodynamic decompensation, intracranial bleeding, major bleeding, and death, as well as on the changes in the mean pulmonary artery pressure (mPAP) before and after CDT. We predefined three subgroups of at-risk patients: (i) older age (i.e. ≥75 years), (ii) active cancer, and (iii) surgery in the prior 4 weeks. Results We studied 1244 patients, of whom 586 (47.1%) were women. The median age was 61 (Q1-Q3; 50-71) years. There were 202 (16.3% of total available) patients aged 75 years or older, 101 (10%) with active cancer, and 108 (14.8%) with prior surgery. A total of 946 (89.3%) patients had intermediate-risk PE, and 113 (10.7%) were classified in the high-risk group. Patients aged ≥75 years more frequently suffered haemodynamic decompensation (7.5% vs 1.6% aged &amp;lt;75 years; p&amp;lt; 0.001), major bleeding (12.7% vs 4.5%; p&amp;lt;0.001), and death (9.2% vs 2.2%; p&amp;lt;0.001); Table 1. In a multivariable logistic regression model, age remained associated with death, major bleeding, and haemodynamic decompensation after adjustment for a key prognostic factor (high-risk PE). The same, except for decompensation, was observed after conditioning for sex, high-risk PE, and cancer status. Patients with active cancer showed a tendency to a higher 30-day case fatality when compared with patients with no active cancer, without reaching statistical significance; Table 1. Recent surgery did not appear to influence the outcome rate in this cohort. No differences were found among the three subgroups regarding the reduction of the mPAP following CDT ; Table 2. Conclusions Our results point to age as a strong predictor of early mortality and decompensation in patients undergoing CDT, even after adjusting for the higher rate of high-risk PE in the elderly. The clinical net benefit of CDT in the elderly when accounting for bleeding and the risk of haemodynamic decompensation remains unclear.Efficacy and safety outcomes of CDTmPAP values before and after CDT

Three-year quality of life and its effect on functional limitation and anticoagulation adherence in patients with acute pulmonary emboli

Abstract Introduction Quality of life disturbance is among important consequences of acute pulmonary emboli (PE) which result in a long-standing mental burden affecting functional ability, social life and patients’ adherence to assigned treatment. However, the long-term effect of disturbed quality of life is poorly studied. Of note, many survivors are recommended to continue their antithrombotic regimen until "indefinite period" on which the effect of quality of life impairment is unknown. Purpose To report the 3-year changes in quality of life and its effect on functional limitation and anticoagulation adherence in patients with acute PE. Methods In our prospective registry, 170 consecutive patients with acute PE were recruited. Six-month clinical, imaging and functional status were previously published. In the current study, survivors were asked to participate in a 3-year structural follow up consisting of clinical examination, transthoracic echocardiography (including Pulmonary EmbolIsm THrOmbolysis (PEITHO) right ventricle (RV) functional recovery), 6-minute walk test and quality of life assessment based on Pulmonary Embolism Quality of Life Questionnaire (PEmb-QoL). The use of antithrombotic drugs was also evaluated. Results Of the 170 registered patients, during the 3-year follow-up time, 37 (21.8%) died and 16 (9.4%) were lost to follow-up. 117 patients were followed clinically, of whom 73 patients (median age 49 (37-61) years and 29 (39.7%) were female) accepted to participated in the all steps of the structural follow up. 45 (61.6%), 25 (34.3%) and 3 (4.1%) patients have complete, incomplete and no RV recovery in the 3-year echocardiogram exam, respectively. Three-year median 6MWT was 400 (320-460) meters. 33 (45%) patients did not adhere to the instructed antithrombotic regimen. In 51 patients 6-month and 3-year Pem-QoL questionnaires were available. The mean PEmb-QoL scores improved overall and in all dimensions (Figure 1). Better quality of life was not associated with RV function recovery, 6MWT results or antithrombotic adherence. Conclusion Our study showed a significant improvement in quality of life in PE survivors followed for 3 years. QoL was not associated with echocardiographic parameters or 6-minute walking test.PEmb-QoL in 6-month and 3-year Follow up

Effectiveness and safety of catheter-directed thrombolysis for acute pulmonary embolism: a systematic review and meta-analysis

Abstract Background Catheter-directed thrombolysis (CDT) can accelerate relief of the right ventricle overload secondary to acute pulmonary embolism (PE). The effectiveness and safety of CDT, also in relation to dose, duration, and different devices, are still a matter of debate. Purpose We conducted a systematic review and meta-analysis to assess effectiveness and safety of CDT for intermediate- and high-risk acute PE. Methods We systematically searched PubMed, Web of Science and CENTRAL (inception-December 2022) and selected randomized controlled trials (RCTs), observational studies, and epidemiological analysis (DRG-based, nationwide studies), focusing on standard CDT (sCDT) vs. ultrasound-assisted catheter-directed thrombolysis (USAT) for intermediate- and high-risk acute PE, according to European Society of Cardiology definition. We obtained pooled estimate rates for bleeding (intracranial and major), in-hospital/30-day fatality rate, and estimated the early improvement of several hemodynamic parameters (i.e. right/left ventricle [RV/LV] ratio, pulmonary artery pressure [PAP]) and long-term course. Results Overall, 58 studies with 37,496 patients (mean age 60 years) were included. The pooled intracranial bleeding rate was 0.15% (95%CI: 0-0.58%) in trials and cohort studies, and 0.87% (95%CI: 0.44-1.42%) in epidemiological studies; Fig. 1. Randomized trials comparing CDT vs. anticoagulation alone reported neither intracranial nor fatal bleeding events. In trials and cohort studies, higher rates of major bleedings were observed with longer (4.5%; 95%CI: 2.4-7.1%) vs. shorter (0.7%, 95%CI: 0-2.2%) treatment duration (p=0.01), irrespective of the dose; Fig. 2. Longer CDT regimens were associated with a high fatality rate of 2.8% (95%CI: 1.5-4.2%) vs. 0.1% (95%CI: 0-1.1%) with shorter CDT treatment (&amp;lt;0.01), disregarding the lytic dose; Fig. 2. All early hemodynamic and radiological outcomes assessed in available studies improve after CDT regardless of dose, duration, and type of device. However, data on the long-term course of PE after CDT has been rarely reported in literature. Conclusions The available evidence supports the notion that CDT strategies may represent a safe option for reversing right ventricular dysfunction due to acute PE. Overall, the reported rate of intracranial bleeding was below 1%. Patients exposed to longer CDT regimens had a higher incidence of major bleeding and fatality. Randomised trials with clinical outcomes are necessary to truly establish optimal patient selection and CDT protocol.Prevalence of intracranial bleedingOutcomes in RCTs and cohort studies

Abstract 18303: Characteristics of Clinical Studies Evaluating Thrombolysis and Novel Catheter-Based Interventions for Pulmonary Embolism

Introduction: Novel treatment approaches for pulmonary embolism (PE) including catheter directed thrombolysis (CDT), percutaneous thrombectomy (PT), and systemic thrombolysis (ST) are under investigation. However, characteristics of studies of these interventions are not well described. We sought to evaluate the state of studies pertaining to advanced PE therapies. Methods: The ClinicalTrials.gov (CTG) database was queried using search terms specific to advanced therapies and PE between January 1, 2000, and June 30, 2022, with unrelated, withdrawn, and terminated studies excluded. Advanced therapies were defined as studies evaluating either systemic thrombolysis, CDT, and/or PT. Geographic data from enrollment was gathered using zip codes of study sites. Descriptive characteristics related to studies were explored, and ANOVA was used to compare mean trial enrollment between interventions. Results: Of 700 total results, our search yielded 56 eligible studies (8.0%) investigating advanced PE therapies, among which 39.3% studies evaluated CDT, 32.1% evaluated ST, and 28.6% evaluated MT. Most studies were interventional (76.7%) rather than observational (23.3%). The primary study endpoint was most commonly a surrogate endpoint (60.7%), with mortality (5.4%) or a composite including mortality (21.4%), or other endpoints (12.5%) were less frequent (Figure). Mean enrollment was 206.4 in ST, 101.5 in CDT, and 103.7 in PT studies, with no significant difference in study size between intervention type (p=0.207). The USA was the most frequent trial sponsor (41.1%), and within the USA, trial sites were most commonly in large, urban areas and demonstrated geographic variation. Conclusion In conclusion, there is a paucity of studies evaluating advanced therapies for PE with substantial heterogeneity in design and geography. These data highlight the need for further high-quality studies to inform clinical decision making for the treatment of PE.

Underuse of reperfusion therapy with systemic thrombolysis in high-risk acute pulmonary embolism in a Portuguese center

IntroductionReperfusion therapy is generally recommended in acute high-risk pulmonary embolism (HR-PE), but several population-based studies report that it is underused. Data on epidemiology, management and outcomes of HR-PE in Portugal are scarce. ObjectiveTo determine the reperfusion rate in HR-PE patients, the reasons for non-reperfusion, and how it influences outcomes. MethodsIn this retrospective cohort study of consecutive HR-PE patients admitted to a thromboembolic disease referral center between 2008 and 2018, independent predictors for non-reperfusion were assessed by multivariate logistic regression. PE-related mortality and long-term MACE (cardiovascular mortality, PE recurrence and chronic thromboembolic disease) were calculated according to the Kaplan–Meier method. Differences stratified by reperfusion were assessed using the log-rank test. ResultsOf 1955 acute PE patients, 3.8% presented with hemodynamic instability. The overall reperfusion rate was 50%: 35 patients underwent systemic thrombolysis, one received first-line percutaneous embolectomy and one rescue endovascular treatment. Independent predictors of non-reperfusion were: age, with >75 years representing 12 times the risk of non-treatment (OR 11.9, 95% CI 2.7–52.3, p=0.001); absolute contraindication for thrombolysis (31.1%), with recent major surgery and central nervous system disease as the most common reasons (OR 16.7, 95% CI 3.2–87.0, p<0.001); and being hospitalized (OR 7.7, 95% CI 1.4–42.9, p=0.020). At a mean follow-up of 2.5±3.3 years, the survival rate was 33.8%. Although not reaching statistical significance for hospital mortality, mortality in the reperfusion group was significantly lower at 30 days, 12 months and during follow-up (relative risk reduction of death of 64% at 12 months, p=0.013). Similar results were found for MACE. ConclusionsIn this population, the recommended reperfusion therapy was performed in only 50% of patients, with advanced age and absolute contraindications to fibrinolysis being the main predictors of non-reperfusion. In this study, thrombolysis underuse was associated with a significant increase in short- and long-term mortality and events.