Abstract 8528: Functional Outcome 5 Years After Massive Pulmonary Embolism Treated with Percutaneous Mechanical Thrombectomy or Pharmacologic Therapy
Introduction. Percutaneous mechanical thrombectomy (PMT) has emerged as an effective treatment in patients with massive pumonary embolism (PE). The long-term functional outcome, i.e. development of chronic thromboembolic pulmonary hypertension (CTEPH), after PMT as compared to conventional therapy is unknown.
Hypothesis. Are follow-up data on 5-year outcome different among survivors of massive PE treated either with PMT or drug therapy only?
Methods. We studied 85 survivors of massive PE (defined as mean pulmonary arterial pressure (PAP)>25 mm Hg and Miller index>20/34) from 3 tertiary centers between January 2004 and December 2007. At referral, 52 patients (49±18 years) had thrombolitics and/or heparin (Gr.A), whereas 33 patients (43±13 years) underwent PMT (Angiojet, Possis Medical, Minneapolis, MN) because of relative or absolute contraindications to thrombolytics and/or heparin (Gr.B). All patients were evaluated at 6-month intervals over a 5-year follow-up period after discharge.
Results. While in-hospital, Gr.A showed significant improvement in functional class (from 3.6±1.2 to 2.3±1.1, p<0.001) and increase in oxygen saturation (from 77±21 to 94±19%, p<0.001). In Gr.B, PMT resulted in immediate angiographic improvement in 22/23 patients, with a rapid amelioration in functional class (from 3.3±0.9 to 2.1±0.7, p<0.001) and an increase in oxygen saturation (from 71±15 to 92±17%, p<0.001). At discharge, peak systolic PAP resulted significantly (p<0.001) decreased in both Gr.A (from 57±28 to 35±22 mm Hg) and Gr.B (from 65±31 to 31±19 mm Hg). The clinical improvement was maintained during the follow-up in both groups, and after 5 years a peak systolic PAP>50 mm Hg was recorded in 6/52 Gr.A patients and 2/33 Gr.B patients (12 vs. 6%).
Conclusions. PMT is an effective alternative to pharmacologic treatment for PE, and is associated with a lower tendency to develop CTEPH over 5 years.
- © 2011 by American Heart Association, Inc.