• Nish Patel, Nileshkumar J Patel, Kanishk Agnihotri, Sidakpal S Panaich, Badal Thakkar, Achint Patel, Chirag Savani, Nilay Patel, Shilpkumar Arora, Abhishek Deshmukh, Parth Bhatt, Carlos Alfonso, Mauricio Cohen, Alfonso Tafur, Mahir Elder, Tamam Mohamed, Ramak Attaran, Theodore Schreiber, Cindy Grines, and Apurva O Badheka.
• Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
• Catheter Cardiovasc Interv. 2015 Dec 1; 86 (7): 1219-27.

ObjectiveThe aim of the study was to assess the utilization of catheter-directed thrombolysis (CDT) and its comparative effectiveness against systemic thrombolysis in acute pulmonary embolism (PE).BackgroundContemporary real world data regarding utilization and outcomes comparing systemic thrombolysis with CDT for PE is sparse.MethodsWe queried the Nationwide Inpatient Sample from 2010 to 2012 using the ICD-9-CM diagnosis code 415.11, 415.13, and 415.19 for acute PE. We used propensity score analysis to compare outcomes between systemic thrombolysis and CDT. Primary outcome was in-hospital mortality. Secondary outcome was combined in-hospital mortality and intracranial hemorrhage (ICH).ResultsOut of 110,731 patients hospitalized with PE, we identified 1,521 patients treated with thrombolysis, of which 1,169 patients received systemic thrombolysis and 352 patients received CDT. After propensity-matched comparison, primary and secondary outcomes were significantly lower in the CDT group compared to systemic thrombolysis (21.81% vs. 13.36%, OR 0.55, 95% CI 0.36-0.85, P value = 0.007) and (22.89% vs. 13.36%, OR 0.52, 95% CI 0.34-0.80, P value = 0.003), respectively. The median length of stay [7 days, interquartile range (IQR) (5-9 days) vs. 7 days, IQR (5-10 days), P = 0.17] was not significant between the two groups. The CDT group had higher cost of hospitalization [$17,218, IQR ($12,272-$23,906) vs. $23,799, IQR ($17,892-$35,338), P < 0.001]. Multivariate analysis identified increasing age, saddle PE, cardiopulmonary arrest, and Medicaid insurance as independent predictors of in-hospital mortality.ConclusionsCDT was associated with lower in-hospital mortality and combined in-hospital mortality and ICH.© 2015 Wiley Periodicals, Inc.

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