Catheter-directed treatment for acute pulmonary embolism: Systematic review and single-arm meta-analyses

Navkaranbir S. Bajaj, Rajat Kalra, Pankaj Arora, Sameer Ather, Jason L. Guichard, W. Jake Lancaster, Nirav Patel, Fabio Raman, Garima Arora, Firas Al Solaiman, D. Trey Clark, Louis J. Dell'Italia, Massoud A. Leesar, James E. Davies, David C. McGiffin, Mustafa I. Ahmed

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background We sought to estimate the efficacy and safety outcomes of catheter-directed treatment (CDT) for patients with acute pulmonary embolism (PE). Methods We searched SCOPUS for studies reporting outcomes after CDT for acute PE. Studies were categorized in three groups for analyses due to heterogeneity in the classification of acute PE: 1) patients with PE causing right ventricular dysfunction and haemodynamic instability: unstable haemodynamic status, 2) patients with PE causing right ventricular dysfunction where study outcomes were not stratified by haemodynamic status: stable and unstable haemodynamic status, and 3) patients with PE causing right ventricular dysfunction who remained haemodynamically stable: stable haemodynamic status. Efficacy and safety outcomes were estimated and presented as point estimates with 95% confidence intervals. Results In 35 studies with 1253 patients, 1277 CDTs were performed. The in-hospital mortality rates for the unstable haemodynamic status, stable and unstable haemodynamic status, and stable haemodynamic status groups were 18.1% (7.3–38.2%), 7.1% (5.0–10.1%), and 2.6% (0.8–7.3%), respectively. The major bleeding rates across the groups were estimated to be 4.5, 8.5 and 3.9 per 100 CDTs, respectively. Minor bleeding occurred in 6.2, 11.9 and 9.1 per 100 CDTs, respectively. After CDT, all groups had improvements in mean pulmonary artery pressure and right ventricular function. Conclusions We provide descriptive measures of efficacy and safety for patients who underwent CDT for acute PE.

Original languageEnglish (US)
Pages (from-to)128-139
Number of pages12
JournalInternational Journal of Cardiology
Volume225
DOIs
StatePublished - Dec 15 2016

Bibliographical note

Publisher Copyright:
© 2016 Elsevier Ireland Ltd

Keywords

  • Catheter-directed treatment
  • Pulmonary embolism
  • Thrombolysis

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