Comparison of In-Hospital Outcomes and Readmission Rates in Acute Pulmonary Embolism Between Systemic and Catheter-Directed Thrombolysis (from the National Readmission Database)

There are sparse comparative data on in-hospital outcomes and readmission rates in patients with acute pulmonary embolism (PE) who receive systemic thrombolytics versus catheter-directed thrombolysis (CDT). The study cohort was derived from the National Readmission Database 2013 to 2014, subset of t...

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Bibliographic Details
Published in:The American journal of cardiology 2017-11, Vol.120 (9), p.1653-1661
Main Authors: Arora, Shilpkumar, Panaich, Sidakpal S., Ainani, Nitesh, Kumar, Varun, Patel, Nileshkumar J., Tripathi, Byomesh, Shah, Purav, Patel, Nirali, Lahewala, Sopan, Deshmukh, Abhishek, Badheka, Apurva, Grines, Cindy
Format: Article
Language:English
Subjects:
Acute Disease
Age
Aged
Bleeding
Catheters
Codes
Cohort Studies
Confidence intervals
Databases, Factual
Demographics
Embolism
Embolisms
Female
Fibrinolytic Agents - administration & dosage
Greedy algorithms
Health care
Hemorrhage
Hospice care
Hospital Mortality
Humans
Male
Medical instruments
Middle Aged
Mortality
Patient Readmission
Patients
Propensity Score
Pulmonary arteries
Pulmonary Embolism - drug therapy
Pulmonary Embolism - mortality
Pulmonary embolisms
Thrombolysis
Thrombolytic Therapy
Treatment Outcome
Ultrasonic imaging
Variables
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Summary:There are sparse comparative data on in-hospital outcomes and readmission rates in patients with acute pulmonary embolism (PE) who receive systemic thrombolytics versus catheter-directed thrombolysis (CDT). The study cohort was derived from the National Readmission Database 2013 to 2014, subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. Systemic and CDT were identified using appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes. The co-primary outcomes were in-hospital mortality and 30-day readmissions and secondary outcome was combined in-hospital mortality + gastrointestinal bleed + intracranial hemorrhage. We used propensity score match analysis without replacement using Greedy's algorithm to adjust for possible confounders. We identified a total of 4,426 patients (3,107: systemic thrombolysis and 1,319: CDT) with acute PE who were treated with thrombolysis. In our 2:1 propensity score algorithm, in-hospital mortality was lower in the CDT group (6.12%) versus systemic thrombolytics (14.94%) (odds ratio 0.37, 95% confidence interval 0.28 to 0.49, p 
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2017.07.066