Waqas Ahmad, M.B, B.S.
,
Nishtar Medical College, Multan, Pakistan
Dorothy Pei, MD
,
Baylor College of Medicine, Houston, TX
Mahin R Khan, MD
,
McLaren Flint - Michigan State University, Flint, MI
Marwah Shahid, MD
,
Baylor College of Medicine, Houston, TX
Ihab Hamzeh, MD, FACC
,
Baylor College of Medicine, Houston, TX
Salim S Virani, MD
,
Baylor College of Medicine, Houston, TX
Yochai Birnbaum, MD, FACC, FAHA
,
Baylor College of Medicine, Houston, TX
Nasser M Lakkis, M.D., FACC, FSCAI
,
Baylor College of Medicine, Houston, TX
Mahboob Alam, M.D., FSCAI
,
Baylor College of Medicine, Sugarland, TX
Background:
Ultrasound-Accelerated Catheter Directed Thrombolytic Therapy (USAT) is increasingly being used for patients with massive and sub-massive pulmonary embolism. Catheter Directed Thrombolytic Therapy (CDT) has been reported with better safety and efficacy outcomes compared to systemic thrombolytic therapy. There is limited data comparing USAT and CDT especially given the fact that USAT may not be widely available. We sought to compare the efficacy of USAT and CDT in patients with massive and sub-massive pulmonary embolism by performing an aggregate data meta-analysis.
Methods:
An extensive time-unlimited literature search was performed using PubMed, EMBASE and Cochrane databases. Final search resulted in 3 studies comparing USAT and CDT. Baseline demographic and clinical variables as well as procedural details were collected from all these studies. Outcomes of interest were pulmonary artery systolic pressure (PASP, mmHg) before and after treatment and total tPA (tissue plasminogen activator) dose (mg) between the two groups. Meta-analyses were performed using Review Manager 5.3 (Cochrane Collaboration). Effect size was calculated using Mean Difference with 95% confidence intervals and random effects model was employed.
Results:
These studies reported a total of 230 patients (USAT = 89, CDT = 126). Baseline demographic and clinical variables were comparable between the two groups. There was no difference in the total dose of tPA used between the two groups (mean difference 0.97mg, 95% CI -6.03 – 7.98). There was significant reduction in the PASP with USAT (mean reduction -14.13mmHg, 95% CI -17.93 - -10.33) and with CDT (mean reduction -14.47mmHg, 95% CI -18.60 – -10.33). A test of subgroup differences was performed between the two groups which was not significant (P = 0.91). Total in-hospital mortality was 10/230 (4.3%). Subgroup mortality data was available from two studies (3/60, 5% USAT, 1/63, 1.5% CDT) and it was not statistically significant (Chi-square P-value 0.29).
Conclusions:
CDT and USAT used comparable total dose of tPA. Both modalities achieved a significant reduction in PASP and were comparable in terms of efficacy. All-cause mortality, although limited data, was not different between USAT and CDT.
