Abstract 17801: Ultrasound Enhanced Catheter Directed Thrombolysis for Patients With Massive and Submassive Pulmonary Embolism Presenting to the Emergency Department
Introduction: Pulmonary embolism (PE) affects 60-70 per 100,000 population. PE can be risk stratified into non massive, sub massive and massive based on clinical presentation and clot burden. Catheter directed thrombolysis (CDT) is a current strategy for management of massive PE (Class IIa) and has also been recommended by AHA for patients with submassive PE (Class IIb). Ultrasound enhanced (UE) CDT combines ultrasonic clot destruction with local thrombolysis and has been shown to reduce right ventricular dilation (RVD) and clot burden.
Objective: To evaluate the overall effectiveness of UE CDT in the management of massive and submassive PE’s.
Methods: A retrospective cohort of consecutive patients with massive or submassive PE presenting to the ED between 2010-2016, and treated with UE CDT were included in the study. Demographic data along with complications, mortality rate and echocardiographic findings were abstracted from electronic medical records. The calculated Pulmonary Embolism Severity Index (PESI) score was used to grade the severity of the PE. Pearson’s chi-square test was used to assess mortality prevalence in the study cohort versus the PESI study cohort.
Results: A total of 141 patients were included, with a mean age of 60.2 years (SD ± 16.1), with 46.1 % male and 71.6 % African Americans. The mean length of stay was 8.9 (SD ± 8.3) days with an average mortality across all PESI scores of 10.7% (7.7 – 22.3). This was significantly lower (p=0.0011) when compared to the overall mortality in the PESI Study (23.2%, 19.8-27.0), where standard of care was used (Table).
Echocardiography pre (N= 93) and post (N= 139) CDT showed significant improvement with 50 patients exhibiting RVD (95% CI [37.6, 62.4]) pre procedure versus 27 patients (95% CI [17.4, 36.6]) post procedure (p<0.001).
Conclusion: Our data suggests that UE CDT improves the outcomes in patients with higher PESI scores. A prospective case-control study comparing UE CDT with systemic thrombolysis is the next step.
Author Disclosures: V.A. Kumar: None. O. Qaqi: None. C. McLendon: None. M. Mohan: None. A. Singh: None. X. Li: None. Y. Huang: None. M. Elder: Research Grant; Modest; OPTALYSE PE. B. O’Neil: None.
- © 2016 by American Heart Association, Inc.