Unplanned 30-day Readmissions for the Management of Submassive and Massive Acute Pulmonary Embolism: Catheter-Directed versus Systemic Thrombolysis.
Academic Article
Overview
abstract
PURPOSE: To compare 30-day readmission and in-hospital outcomes from the Nationwide Readmission Database for catheter-directed thrombolysis (CDT) versus systemic intravenous thrombolysis (IVT) as treatments for acute submassive or massive pulmonary embolism (PE) . MATERIALS AND METHODS: The Nationwide Readmission Database was queried from 2016 to 2019 for adult patients with non-septic acute PE who underwent IVT or CDT. Massive PE was distinguished from submassive PEs if patients had concurrent ICD codes corresponding to mechanical ventilation, vasopressors, or shock. Propensity score matched analysis was conducted to infer the association of CDT versus IVT in unplanned 30-day readmissions, non-routine discharge, GI bleeding (GIB), and intracranial hemorrhage (ICH). These results are demonstrated as average treatment effects (ATE) of IVT compared to CDT. RESULTS: 37,116 patients with acute PE were studied. 18,702 (50.3%) underwent CDT and 18,414 (49.7%) underwent IVT. 2,083 (11.1%) and 3,423 (18.6%) were massive PEs in the two groups, respectively (p<0.001). The ATE of IVT was higher compared to CDT regarding unplanned 30-day readmissions (ATE: 0.019; p<0.001), GIB (ATE: 0.012; p<0.001), ICH (ATE: 0.003; p=0.017) and non-routine discharge (ATE: 0.022; p=0.006). Subgroup analysis of submassive PE patients demonstrated that IVT had higher ATE regarding unplanned 30-day readmission (ATE: 0.028; p<0.001), GIB (ATE: 0.008; p=0.003), ICH (ATE: 0.002; p=0.035) and non-routine discharge (ATE: 0.019; p=0.022) compared to CDT. CONCLUSION: CDT had a lower likelihood of unplanned 30-day readmissions, including when stratified by submassive PE subtype. Additionally, complications including ICH and GIB were more likely among those who received IVT compared to CDT.
