Journal article
Comparison of In-Hospital Outcomes and Readmission Rates in Acute Pulmonary Embolism Between Systemic and Catheter-Directed Thrombolysis (from the National Readmission Database)
The American journal of cardiology, Vol.120(9), pp.1653-1661
11/01/2017
DOI: 10.1016/j.amjcard.2017.07.066
PMID: 28882336
Abstract
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 <0.001). There was also a lower composite secondary outcome (in-hospital mortality + gastrointestinal bleed + intracranial hemorrhage) in patients who received CDT (8.42%) versus those who received systemic thrombolytics (18.13%) (odds ratio 0.41, 95% confidence interval 0.33 to 0.53, p <0.001). Thirty-day readmission was lower in patients with CDT group (7.65%) compared with systemic thrombolytics (10.58%, p = 0.009). In conclusion, in-hospital mortality, as well as bleeding during primary admission was significantly lower with CDT compared with systemic thrombolytics for patients with acute PE. There was also significant decrease in rate of readmissions among patients receiving CDT compared with systemic thrombolytics.
Details
- Title: Subtitle
- Comparison of In-Hospital Outcomes and Readmission Rates in Acute Pulmonary Embolism Between Systemic and Catheter-Directed Thrombolysis (from the National Readmission Database)
- Creators
- Shilpkumar Arora - Department of Cardiology, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York. Electronic address: dr.shilparora@yahoo.comSidakpal S Panaich - Department of Cardiology, Mayo Clinic, Rochester, MinnesotaNitesh Ainani - Department of Cardiology, Baystate Medical Center, Springfield, MassachusettsVarun Kumar - Department of Cardiology, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New YorkNileshkumar J Patel - Department of Cardiology, University of Miami Miller School of Medicine, Miami, FloridaByomesh Tripathi - Department of Cardiology, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New YorkPurav Shah - Department of Cardiology, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New YorkNirali Patel - Department of Cardiology, University of Southern California, Los Angeles, CaliforniaSopan Lahewala - Department of Internal Medicine, RWJ Barnabas health/Jersey City Medical Center, Jersey City, New JerseyAbhishek Deshmukh - Department of Cardiology, Mayo Clinic, Rochester, MinnesotaApurva Badheka - Department of Cardiology, The Everett Clinic, Everett, WashingtonCindy Grines - Department of Cardiology, Detroit Medical Center, Detroit, Michigan
- Resource Type
- Journal article
- Publication Details
- The American journal of cardiology, Vol.120(9), pp.1653-1661
- DOI
- 10.1016/j.amjcard.2017.07.066
- PMID
- 28882336
- ISSN
- 0002-9149
- eISSN
- 1879-1913
- Language
- English
- Date published
- 11/01/2017
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984094390402771
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