Interventional Therapies in Acute Pulmonary Embolism

Zhang, Robert; Kobayashi, Taisei; Pugliese, Steven C.; Khandhar, Sameer; Giri, Jay

doi:10.1016/j.iccl.2019.12.003

Cited by 12 publications

(13 citation statements)

References 54 publications

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“…The in-hospital mortality rates vary from 3% to 15% despite contemporary treatments. 2 In our cohort of intermediate-risk PE patients, the prevalence of normotensive shock was high (62%). This rate is higher than that in the FLASH registry (34%), suggesting perhaps selection of a higher risk cohort by the local PE response team to undergo MT.…”

mentioning

confidence: 69%

“…All patients undergoing MT underwent invasive hemodynamic evaluation. Normotensive shock was defined as systolic blood pressure ≥90 mm Hg in the absence of vasopressor support with preprocedural invasive measures of CI ≤2.2 L/min per m 2 and clinical evidence of hypoperfusion (ie, elevated lactate, oliguria). The study was approved by the New York University institutional review board, and the procedures followed were in accordance with institutional guidelines.…”

mentioning

confidence: 99%

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Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism

Zhang,

Alam,

Sharp

et al. 2024

Circ: Cardiovascular Interventions

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mentioning

confidence: 69%

mentioning

confidence: 99%

Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism

Zhang,

Alam,

Sharp

et al. 2024

Circ: Cardiovascular Interventions

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“…This modality has been shown to be more effective than anticoagulation alone in restoring vessel patency and more rapidly reversing the acute hemodynamic sequelae of PE. While head‐to‐head randomized trials are sparse, observational data suggests a lower risk of major bleeding with CDT compared to systemic thrombolysis 6–8 . Although other cardiovascular procedures have demonstrated an inverse association between procedural volume and outcomes, 9–11 the association between CDT hospital volume and in‐hospital clinical outcomes remains largely unknown despite growing interest in the procedure 12 .…”

Section: Introductionmentioning

confidence: 99%

“…While head-to-head randomized trials are sparse, observational data suggests a lower risk of major bleeding with CDT compared to systemic thrombolysis. [6][7][8] Although other cardiovascular procedures have demonstrated an inverse association between procedural volume and outcomes, [9][10][11] the association between CDT hospital volume and in-hospital clinical outcomes remains largely unknown despite growing interest in the procedure. 12 The objective of this study was to examine the association between hospital volume of CDT for pulmonary embolism and in-hospital clinical outcomes using a national representative database.…”

mentioning

confidence: 99%

Association of annual volume and in‐hospital outcomes of catheter‐directed thrombolysis for pulmonary embolism

Jung

Simard

Hibbert

et al. 2022

Cathet Cardio Intervent

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Objective: We sought to evaluate the association between the institutional volume of catheter-directed thrombolysis (CDT) for pulmonary embolism and in-hospital mortality.Background: CDT is an increasingly utilized therapy in patients with intermediate/ high-risk PE. However, data on the relationship between hospital volume and clinical outcomes remain limited.Methods: Patients who underwent CDT between October 1, 2015, and March 31, 2021, were identified in the Vizient Clinical Database. The primary outcome was inhospital mortality. Secondary outcome were major complications, length of stay, and cost. Hospitals were dichotomized into <8 and ≥8 cases/year following restricted cubic spline analysis.Results: A total of 6741 CDT procedures at 171 hospitals were included with a median annual hospital volume of 4.1 cases (IQR = 1.9-8.3). A total of 44 hospitals (25.7%) were classified as high-volume (≥8 cases/year) and performed 60.9% of all CDT cases. CDT at high-volume centers was associated with lower in-hospital mortality (6.0% vs. 11.3%; p < 0.0001). Stroke and bleeding rates were similar, but pulmonary complications were more frequent at low-volume centers. CDT at high volume centers was associated with a significantly shorter length of stay and lower cost. The association between high CDT volume and in-hospital mortality persisted after adjustment for demographics (odds ratio [OR] = 0.49, [0.41-0.58]), demographics and risk factors (OR = 0.52 [0.44-0.62]), and demographics, risk factors, and troponin elevation (OR = 0.51 [0.40-0.66]). Conclusion: In a large contemporary cohort of patients undergoing CDT in the United States, low annual institutional volume of CDT was associated with higher inhospital mortality.

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“…[ 1 ] It has been estimated that only 7% of the patients with PE who died were correctly diagnosed before death. [ 2 ] Genetic abnormalities in proteins involved in the coagulation pathway leading to hypercoagulability have been found to be the cause of thrombophilia disease. Factor V Leiden (FV Leiden) and prothrombin G20210A gene mutations are highly prevalent in the Caucasian population.…”

Section: Introductionmentioning

confidence: 99%

Compound heterozygous protein C deficiency with pulmonary embolism caused by a novel PROC gene mutation: Case report and literature review

Zhang

Yang

Chen³

et al. 2022

Medicine

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Rationale: Protein C is an anticoagulation agent, and protein C deficiency results in vascular thrombosis disease. Hereditary protein C deficiency is a risk factor for pulmonary embolism in adults. Pathogenic variants of the Protein C, Inactivator Of Coagulation Factors Va And VIIIa (PROC) gene which encodes protein C have been identified as a cause of protein C deficiency. Patient concerns: We describe a patient with a novel mutation in the PROC gene who was diagnosed with pulmonary embolism in a Chinese family. Diagnosis: According to the results of the pulmonary computed tomography angiography (CTA) and the level of blood protein C, the patient was diagnosed with pulmonary embolism caused by protein C deficiency. Interventions: Whole-exome sequencing (WES) was performed for the molecular analysis. Outcome: The results of patient’s deoxyribonucleic acid revealed a heterozygous mutation (c.237 + 5G > A) in intron 3 of the PROC gene. His father also harbored the same mutation in the PROC gene. We also reviewed the protein C deficiencies caused by PROC gene mutations in cases. Lessons: A novel mutation in intron 3 of PROC gene has not been previously reported in patients with pulmonary embolism caused by protein C deficiency. After anticoagulation therapy, the patient recovered, and CT showed resolution of the thrombosis. Pulmonary embolism may be caused by protein C deficiency and the rare compound heterozygous mutation in intron 3 of the PROC gene could cause protein C deficiency via impairment of the secretory activity of protein C.

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Interventional Therapies in Acute Pulmonary Embolism

Cited by 12 publications

References 54 publications

Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism

Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism

Association of annual volume and in‐hospital outcomes of catheter‐directed thrombolysis for pulmonary embolism

Compound heterozygous protein C deficiency with pulmonary embolism caused by a novel PROC gene mutation: Case report and literature review

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