Pulmonary vascular disease & thromboembolismCohort study
Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism
- Retrospective registry analysis
- PERT Consortium Registry
Authors' conclusion
In the largest analysis of high-risk PE patients to date, mortality rates were high with the worst outcomes among patients with hemodynamic collapse.
Study context
- Population
- Patients with intermediate-risk, high-risk and catastrophic pulmonary embolism (PE) in the PERT Consortium Registry
- Participants
- 5,790 registry patients
- Exposure
- High-risk PE vs Intermediate-risk PE
- High-risk PEn = 1,442
- Intermediate-risk PEn = 2,976reference
- Catastrophic PEn = 197
Main finding
As reported in the abstract
In-hospital mortality
P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Factors associated with in-hospital mortality in high-risk PE (multivariable regression) — Vasopressor use vs Intermediate-risk PE | 4.56 (3.27–6.38) | P < 0.01 | |
| Factors associated with in-hospital mortality in high-risk PE (multivariable regression) — Extracorporeal membrane oxygenation use vs Intermediate-risk PE | 2.86 (1.12–7.30) | P = 0.03 | |
| Factors associated with in-hospital mortality in high-risk PE (multivariable regression) — Identified clot-in-transit vs Intermediate-risk PE | 2.26 (1.13–4.52) | P = 0.02 | |
| Factors associated with in-hospital mortality in high-risk PE (multivariable regression) — Malignancy vs Intermediate-risk PE | 1.70 (1.13–2.56) | P = 0.01 | |
| 0.10.31310Odds ratio (log scale) |
| Outcome | High-risk PE | Intermediate-risk PE | Catastrophic PE | Estimate | P value |
|---|---|---|---|---|---|
| Advanced therapies | 41.9% | 30.2% | Not reported in the abstract | P < 0.001 | |
| In-hospital mortality, catastrophic vs noncatastrophic high-risk PE (subgroup) | Not reported in the abstract | Not reported in the abstract | 42.1% | P < 0.001 | |
| Extracorporeal membrane oxygenation and systemic thrombolysis, catastrophic vs noncatastrophic high-risk PE (subgroup) | |||||
| Extracorporeal membrane oxygenation | Not reported in the abstract | Not reported in the abstract | 13.3% | P < 0.001 | |
| Systemic thrombolysis | Not reported in the abstract | Not reported in the abstract | 25% | P < 0.001 |
- In-hospital mortality, catastrophic vs noncatastrophic high-risk PE (subgroup): Noncatastrophic high-risk PE 17.2%
- In-hospital mortality, catastrophic vs noncatastrophic high-risk PE (subgroup): Catastrophic PE n = 197 [13.7% of high-risk PE patients]
- Extracorporeal membrane oxygenation and systemic thrombolysis, catastrophic vs noncatastrophic high-risk PE (subgroup): Noncatastrophic high-risk PE Extracorporeal membrane oxygenation 4.8% · Systemic thrombolysis 11.3%
Safety
| Outcome | High-risk PE | Intermediate-risk PE | Catastrophic PE | P value |
|---|---|---|---|---|
| Major bleeding | 10.5% | 3.5% | Not reported in the abstract | P < 0.001 |
Original publication
Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism. J Am Coll Cardiol. Published 2 January 2024. doi:10.1016/j.jacc.2023.10.026
Summarised from the published abstract; every number is checked against it