OC 53.5 - Clinical outcomes in patients with acute pulmonary embolism undergoing ultrasound-assisted catheter-directed thrombolysis

Tuesday, June 27, 2023

11:45 – 12:00 ET

Room: 520

Session Available As: On-Demand

Presenting Author(s)

Dominik F. Draxler, MD PhD MBA (he/him/his)

Fellow interventional cardiology
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
Bern, Bern, Switzerland

Co-Author(s)

JJ

Judith Johannes

resident
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
Bern, Bern, Switzerland
ET

Elisabeth Turovskij

Master student
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
Bern, Bern, Switzerland
CD

Caglayan Demirel

Clinical cardiologist
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
Bern, Bern, Switzerland
DH

Dierik Heg

Head of Cardiovascular Health, CTU Bern
CTU Bern, University of Bern, Switzerland
Bern, Bern, Switzerland
SD

Stephan Dobner

Cardiology consultant
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
Bern, Bern, Switzerland
SW

Stephan Windecker

Director, University clinic of cardiology, Inselspital Bern
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
Bern, Bern, Switzerland
SS

Stefan Stortecky

Director, Pulmonary Embolism Center, Inselspital
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
Bern, Bern, Switzerland

Background: Acute pulmonary embolism (APE) is the third leading cause of cardiovascular mortality. Systemic thrombolysis can achieve rapid reperfusion for APE, but is associated with a substantial risk for major bleeding. Observational research data indicate favorable clinical outcomes using catheter-directed reperfusion techniques for these individuals.

Aims: The aim of this study was to investigate the benefits and risks of ultrasound-assisted catheter-directed thrombolysis (USAT) in a large patient population with APE.

Methods: ERASE PE is a single-center, cohort study investigating the safety and effectiveness of treatment for APE according to the decision of the local pulmonary embolism response team. The pre-specified primary outcome was in-hospital mortality.

Results: Between October 2017 and September 2022 282 patients (mean age 64.6±14.3 years; 37% female) with high (n=56, 20%) and intermediate-high risk (n=218, 77%) APE were treated with USAT. Patients presented with tachycardia (HR 104.0±20.2bpm), hypoxemia (SpO2 89.2±7.3%), elevated mean pulmonary artery pressures (mPAP 30.9±8mmHg) and reduced mixed venous saturation (SvO2 58.4±10.3%). Patients were treated with USAT using a cumulative dose of 19.8±6.9mg rt-PA over 14.4±2.2hours. After treatment, an improvement of pulmonary artery pressure was observed in 89% of patients with a mean reduction of mPAP of 8.4 mmHg.
The primary endpoint, in-hospital death, was observed in 9 patients (3.2%). One patient had an embolic stroke (0.4%), 24 patients (8.5%) a bleeding event and three patients (1.1%) developed recurrent pulmonary embolism. Bleeding was mainly observed at the vascular access (n=9, 3.2%), whereas intracranial hemorrhage occurred in 3 patients (1.1%).

Conclusion(s): Among patients with APE, USAT effectively reduced right ventricular overload and pulmonary artery pressure. Rates of in-hospital mortality and bleeding are comparable to data from previously published reports of patient cohorts with similar APE risk stratification. Further research is warranted to unveil the differences in treatment response and facilitate an optimal benefit-risk ratio for the individual patient.

Learning Objectives:

... understand the importance of acute pulmonary embolism as the third leading cause of cardiovascular mortality, based on epidemiological data
... understand the role of thrombolysis in the treatment of high- and intermediate risk acute pulmonary embolism
... describe efficacy and safety of ultrasound-assisted catheter-directed thrombolysis in acute pulmonary embolism patients, based on the findings of the ERASE-PE study