Early and mid-term clinical results of acute pulmonary embolism treatment

Abstract

Objective To analyze the clinical characteristics, risk factors, treatment, and prognosis of patients with acute pulmonary embolism (PE), as well as investigate the efficacy of different treatments and their outcomes. Methods In this retrospective cohort study, clinical data of patients diagnosed with acute PE at the University of Hong Kong-Shenzhen Hospital between January 2016 and December 2023 were collected. The epidemiological characteristics, clinical symptoms and signs, risk stratification, risk factors, imaging features, treatments and outcomes were analyzed with t-tests and chi-square tests to investigate the efficacy and outcomes of different treatments for acute PE. Results A total of 294 cases with acute PE (161 males and 133 females, mean age 60.1±17.5 years old) were collected, including 265 cases in the non-high-risk group and 29 cases in the high-risk group based on hemodynamics. There were no statistically significant differences in terms of age, sex ratio or the proportion of patients with concomitant lower extremity deep vein thrombosis (DVT) between the two groups (P>0.05). Among them, 180 cases (61.2%) had PE-related symptoms, and 51 cases (17.3%) were hospital-acquired PE. The proportion of hospital-acquired PE in the high-risk group was significantly higher than that in the non-high-risk group with statistically significant differences (41.4% (12/29) vs 14.7% (39/265), χ 2=12.96 P<0.01). There were 197 cases (67.0%) with concomitant lower extremity DVT, mainly mixed and proximal DVT (158 cases, 80.2%). More than half of PE cases had bilateral pulmonary thrombosis (183, 62.2%). The proportion of bilateral pulmonary thrombosis (93.1% (27/29) vs 58.9% (156/265), χ 2=13.22, P<0.01) and main pulmonary artery thrombosis (79.3% (23/29) vs 39.6% (105/265), P<0.05) were significantly higher in the high-risk group than that in the non-high-risk group with statistically significant differences. All 265 non-high-risk PE cases underwent anticoagulant therapy. Among 29 high-risk PE cases, 1 case did not receive PE therapy due to sudden death, and 7 cases only received anticoagulant therapy before the death due to the contraindications to thrombolysis and the lack of opportunities for thrombolysis caused by cardiac arrest. The other 21 cases received multiple treatments besides anticoagulant therapy. Among the 21 cases, 1 received intravenous thrombolytic therapy (who died then due to cardiac arrest), 20 successfully underwent pulmonary artery interventional therapy (18 then underwent reperfusion therapy; 1 encountered failed catheter placement, and 1 had complications of cardiac tamponade, both died during the perioperative period). Within the 20 cases, 16 received inferior vena cava filter placement at the same time. Main interventional treatments included catheter-directed thrombolysis (3, 15.0%), mechanical thrombectomy and/or balloon dilatation (7, 35.0%), and catheter-directed thrombolysis + mechanical thrombectomy and/or balloon dilatation (10, 50.0%). Among 294 cases with acute PE, 9 cases died of PE (3.1%), all were from the high-risk group, accounting for 31.0% of the group. 271 cases obtained follow-up for (41.3±17.4) months (range: 5.9-60.0 months). There were 7 cases of PE recurrence (2.6%) in the non-high-risk group and no recurrence among cases with pulmonary artery intervention within 5 years, showing no statistically significant differences in the recurrence rate (P=0.376) between two treatment methods. Conclusion Patients with non-high-risk PE can have a favorable prognosis through anticoagulant therapy, and the utilization of multiple interventional treatments in high-risk PE patients was associated with satisfactory efficacy.