AIMS Pulmonary embolism (PE) is the third most common cardiovascular cause of death; systemic thrombolysis is potentially lifesaving treatment in patients presenting with haemodynamic instability. We investigated trends in the use of systemic thrombolysis and the outcome of patients with acute PE. METHODS AND RESULTS We analysed data on the characteristics, comorbidities, treatment, and in-hospital outcome of 885 806 PE patients in Germany between 2005 and 2015. Incidence of acute PE was 99/100 000 population/year and increased from 85/100 000 in 2005 to 109/100 000 in 2015 [β 0.32 (0.26-0.38), P < 0.001]. During the same period, in-hospital case fatality rates decreased from 20.4% to 13.9% [β -0.51 (-0.52 to -0.49), P < 0.001]. The overall proportion of patients treated with systemic thrombolysis increased from 3.1% in 2005 to 4.4% in 2015 [β 0.28 (0.25-0.31), P < 0.001]. Thrombolysis was associated with lower in-hospital mortality rates in patients with haemodynamic instability, both in those with shock not necessitating cardiopulmonary resuscitation (CPR) or mechanical ventilation [odds ratio (OR) 0.42 (0.37-0.48), P < 0.001], and in those who underwent CPR [OR 0.92 (0.87-0.97), P = 0.002]. This association was independent from age, sex, and comorbidities. However, systemic thrombolysis was administered to only 23.1% of haemodynamically unstable patients. CONCLUSION Although the proportion of PE patients treated with systemic thrombolysis increased slightly in Germany between 2005 and 2015, only the minority of haemodynamically unstable patients currently receive this treatment. In the nationwide inpatient cohort, thrombolytic therapy was associated with reduced in-hospital mortality rates in PE patients with shock, and also in those who underwent CPR.

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德国溶栓治疗的趋势和急性肺栓塞的结果

AIMS 肺栓塞 (PE) 是第三大最常见的心血管死亡原因；对于血流动力学不稳定的患者，全身溶栓可能是挽救生命的治疗方法。我们调查了全身溶栓的使用趋势和急性 PE 患者的预后。方法和结果 我们分析了 2005 年至 2015 年德国 885 806 名 PE 患者的特征、合并症、治疗和住院结果的数据。急性 PE 的发生率为 99/100 000 人/年，从 85/100 000 2005 年至 2015 年的 109/100 000 [β 0.32 (0.26-0.38), P < 0.001]。同期，住院病死率从 20.4% 降至 13.9% [β -0.51（-0.52 至 -0.49），P < 0.001]。接受全身溶栓治疗的患者总体比例从 2005 年的 3.1% 增加到 4%。2015 年为 4% [β 0.28 (0.25-0.31), P < 0.001]。溶栓与血流动力学不稳定患者的院内死亡率较低相关，无论是在不需要心肺复苏 (CPR) 或机械通气的休克患者中 [比值比 (OR) 0.42 (0.37-0.48)，P < 0.001]，以及在接受 CPR 的患者中 [OR 0.92 (0.87-0.97), P = 0.002]。这种关联与年龄、性别和合并症无关。然而，只有 23.1% 的血流动力学不稳定患者接受了全身溶栓治疗。结论 尽管 2005 年至 2015 年德国接受全身溶栓治疗的 PE 患者比例略有增加，但目前只有少数血流动力学不稳定的患者接受这种治疗。在全国住院患者队列中，