2018 Volume 59 Issue 2 Pages 367-371
High-risk pulmonary embolism (PE) with hypotension, circulatory failure, or cardiac arrest is a rare, but life-threating condition. Many guidelines recommend that thrombolytic therapy is the first-line therapy for this condition and surgical embolectomy is an alternative treatment. However, nationwide data have been lacking on patient characteristics and practice patterns for high-risk PE in a real-world clinical setting.
We defined high-risk PE patients as those who received noradrenaline and underwent surgical embolectomy or thrombolysis within one day after admission. Using a Japanese national inpatient database, we identified high-risk PE patients from July 2010 to March 2014, and divided them into patients with and without embolectomy and those with and without cardiopulmonary arrest (CPA) at admission. We examined variation in patient backgrounds, procedures, and outcomes in this population.
We identified 361 patients were eligible. Among those, including 266 received thrombolysis and 95 received embolectomy. The 30-day mortality was 41.4% in 266 patients with thrombolysis, and 14 patients died in 95 patients with embolectomy. Among the thrombolysis group, 30-day mortality was 35% in 187 patients without CPA thrombolysis and was 56% in 79 patients with CPA. Among the embolectomy group, 30-day mortality was 14% in 81 patients without CPA, and 21% patients died in 14 patients with CPA.
The present nationwide study showed that surgical embolectomy had a relatively low mortality. Further studies are needed to verify the comparative effectiveness of embolectomy.