| アブストラクト | BACKGROUND: Evidence is limited regarding the comparative effectiveness and safety of mechanical thrombectomy (MT) vs catheter-directed thrombolysis (CDT) for high-risk pulmonary embolism (PE). OBJECTIVES: This observational study aimed to compare the outcomes of older adults with high-risk PE treated with MT vs CDT using a target trial emulation framework. METHODS: We included Medicare fee-for-service beneficiaries aged 65 to 99 years admitted with high-risk PE (defined by cardiac arrest, shock, and vasopressor use) who underwent MT/CDT from 2017 to 2020. We evaluated 1-year mortality using an inverse probability of treatment weighting approach, controlling for 62 baseline covariates. We also evaluated readmissions and in-hospital outcomes, including intracranial hemorrhage. Patients were followed from the date of the index procedure to the outcomes of interest, 1 year, or December 2020. RESULTS: We included 235 and 484 patients in the MT and CDT groups, respectively. The absolute risk of 1-year mortality was 48.4% (95% CI: 34.1%-63.3%) in the MT group and 45.4% (95% CI: 37.8%-55.8%) in the CDT group, with an adjusted HR of 1.16 (95% CI: 0.84-1.59). We found no evidence that all-cause readmission (MT vs CDT; subdistribution HR: 0.89; 95% CI: 0.56-1.40), intracranial hemorrhage (adjusted OR: 0.36; 95% CI: 0.07-1.77), or transfusions (adjusted OR: 0.96; 95% CI: 0.52-1.76) differed significantly between the 2 groups. CONCLUSIONS: Among older adults with high-risk PE treated with catheter-based therapies, the clinical outcomes were similar between the patients treated with MT vs CDT. Randomized trials are needed to confirm our findings. |
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| 投稿者 | Watanabe, Atsuyuki; Kuno, Toshiki; Miyamoto, Yoshihisa; Ueyama, Hiroki A; Gotanda, Hiroshi; Bangalore, Sripal; Tsugawa, Yusuke |
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| 組織名 | Department of Medicine, Mount Sinai Morningside and West, Icahn School of;Medicine at Mount Sinai, New York, New York, USA.;Cardiology Division, Massachusetts General Hospital, Harvard Medical School,;Boston, Massachusetts, USA. Electronic address: kuno-toshiki@hotmail.co.jp.;Department of Real-World Evidence, The University of Tokyo, Tokyo, Japan.;Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia,;USA.;Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles,;California, USA.;Division of Cardiology, New York University Grossman School of Medicine, New;York, New York, USA.;Division of General Internal Medicine and Health Services Research, David Geffen;School of Medicine at The University of California, Los Angeles, Los Angeles,;California, USA; Department of Health Policy and Management, UCLA Fielding School;of Public Health, Los Angeles, Los Angeles, California, USA. |
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