Purpose

To compare 30-day readmission and in-hospital outcomes from the Nationwide Readmissions Database (NRD) for catheter-directed thrombolysis (CDT) versus systemic intravenous thrombolysis (IVT) as treatments for acute submassive or massive pulmonary embolism (PE).

Materials and Methods

The NRD was queried from 2016 to 2019 for adult patients with nonseptic acute PE who underwent IVT or CDT. Massive PE was distinguished from submassive PE if patients had concurrent International Classification of Diseases (ICD-10) codes corresponding to mechanical ventilation, vasopressors, or shock. Propensity score–matched analysis was conducted to infer the association of CDT versus IVT in unplanned 30-day readmissions, nonroutine discharge, gastrointestinal bleeding (GIB), and intracranial hemorrhage (ICH). These results are demonstrated as average treatment effects (ATEs) of IVT compared with those of CDT.

Results

A total of 37,116 patients with acute PE were studied; 18,702 (50.3%) underwent CDT, and 18,414 (49.7%) underwent IVT. A total of 2,083 (11.1%) and 3,423 (18.6%) were massive PEs in the 2 groups, respectively (P < .001). The ATE of IVT was higher than that of CDT regarding unplanned 30-day readmissions (ATE, 0.019; P < .001), GIB (ATE, 0.012; P < .001), ICH (ATE, 0.003; P = .017), and nonroutine discharge (ATE, 0.022; P = .006). The subgroup analysis of patients with submassive PE demonstrated that IVT had a higher ATE regarding unplanned 30-day readmission (ATE, 0.028; P < .001), GIB (ATE, 0.008; P = .003), ICH (ATE, 0.002; P = .035), and nonroutine discharge (ATE, 0.019; P = .022) than CDT.

Conclusions

CDT had a lower likelihood of unplanned 30-day readmissions, including when stratified by a submassive PE subtype. Additionally, adverse events, including ICH and GIB, were more likely among patients who received IVT than among those who received CDT.

中文翻译：

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亚大块和大块急性肺栓塞治疗后 30 天计划外再入院：导管引导与全身溶栓

目的

比较全国再入院数据库 (NRD) 中导管定向溶栓 (CDT) 与全身静脉溶栓 (IVT) 治疗急性次大块或大块肺栓塞 (PE) 的 30 天再入院和住院结果。

材料和方法

查询了 2016 年至 2019 年接受 IVT 或 CDT 的非脓毒性急性 PE 成年患者的 NRD。如果患者同时具有对应于机械通气、升压药或休克的国际疾病分类 (ICD-10) 代码，则可将大面积 PE 与次大面积 PE 区分开来。进行倾向评分匹配分析以推断 CDT 与 IVT 在计划外 30 天再入院、非常规出院、胃肠道出血 (GIB) 和颅内出血 (ICH) 中的关联。这些结果被证明为 IVT 与 CDT 相比的平均治疗效果 (ATE)。

结果

共研究了 37,116 名急性肺栓塞患者；18,702 (50.3%) 人接受了 CDT，18,414 (49.7%) 人接受了 IVT。两组中分别有 2,083 (11.1%) 例和 3,423 (18.6%) 例为大块 PE（P < .001）。在计划外 30 天再入院方面，IVT 的 ATE 高于 CDT（ATE，0.019；P < .001）、GIB（ATE，0.012；P < .001）、ICH（ATE，0.003；P  = .017）和非常规放电（ATE，0.022；P  = .006）。次大面积 PE 患者的亚组分析表明，IVT 在计划外 30 天再入院方面具有更高的 ATE（ATE，0.028；P < .001）、GIB（ATE，0.008；P  = .003）、ICH（ATE，0.002；P = .003）P = .035）和非常规放电（ATE，0.019；P  = .022）高于 CDT。

结论

CDT 计划外 30 天再入院的可能性较低，包括按次大 PE 亚型分层时。此外，接受 IVT 的患者比接受 CDT 的患者更容易发生不良事件，包括 ICH 和 GIB。