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Results From the United States Chronic Thromboembolic Pulmonary Hypertension Registry: Enrollment Characteristics and 1-Year Follow-up.
- Source :
-
Chest [Chest] 2021 Nov; Vol. 160 (5), pp. 1822-1831. Date of Electronic Publication: 2021 Jun 04. - Publication Year :
- 2021
-
Abstract
- Background: The United States Chronic Thromboembolic Pulmonary Hypertension Registry (US-CTEPH-R) was designed to characterize the demographic characteristics, evaluation, clinical course, and outcomes of surgical and nonsurgical therapies for patients with chronic thromboembolic pulmonary hypertension.<br />Research Question: What are the differences in baseline characteristics and 1-year outcomes between operated and nonoperated subjects?<br />Study Design and Methods: This study describes a multicenter, prospective, longitudinal, observational registry of patients newly diagnosed (< 6 months) with CTEPH. Inclusion criteria required a mean pulmonary artery pressure ≥ 25 mm Hg documented by right heart catheterization and radiologic confirmation of CTEPH. Between 2015 and 2018, a total of 750 patients were enrolled and followed up biannually until 2019.<br />Results: Most patients with CTEPH (87.9%) reported a history of acute pulmonary embolism. CTEPH diagnosis delays were frequent (median, 10 months), and most patients reported World Health Organization functional class 3 status at enrollment with a median mean pulmonary artery pressure of 44 mm Hg. The registry cohort was subdivided into Operable patients undergoing pulmonary thromboendarterectomy (PTE) surgery (n = 566), Operable patients who did not undergo surgery (n = 88), and those who were Inoperable (n = 96). Inoperable patients were older than Operated patients; less likely to be obese; have a DVT history, non-type O blood group, or thrombophilia; and more likely to have COPD or a history of cancer. PTE resulted in a median pulmonary vascular resistance decline from 6.9 to 2.6 Wood units (P < .001) with a 3.9% in-hospital mortality. At 1-year follow-up, Operated patients were less likely treated with oxygen, diuretics, or pulmonary hypertension-targeted therapy compared with Inoperable patients. A larger percentage of Operated patients were World Health Organization functional class 1 or 2 at 1 year (82.9%) compared with the Inoperable (48.2%) and Operable/No Surgery (56%) groups (P < .001).<br />Interpretation: Differences exist in the clinical characteristics between patients who exhibited operable CTEPH and those who were inoperable, with the most favorable 1-year outcomes in those who underwent PTE surgery.<br />Clinical Trial Registration: ClinicalTrials.gov; No.: NCT02429284; URL: www.clinicaltrials.gov.<br /> (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Antihypertensive Agents therapeutic use
Female
Functional Status
Humans
Longitudinal Studies
Male
Middle Aged
Outcome and Process Assessment, Health Care
Oxygen Inhalation Therapy methods
Oxygen Inhalation Therapy statistics & numerical data
Pulmonary Wedge Pressure
Registries
Risk Assessment
Risk Factors
United States epidemiology
Vascular Resistance
Conservative Treatment methods
Conservative Treatment statistics & numerical data
Endarterectomy adverse effects
Endarterectomy methods
Endarterectomy statistics & numerical data
Hypertension, Pulmonary epidemiology
Hypertension, Pulmonary etiology
Hypertension, Pulmonary physiopathology
Hypertension, Pulmonary therapy
Pulmonary Embolism complications
Pulmonary Embolism diagnostic imaging
Pulmonary Embolism surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1931-3543
- Volume :
- 160
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Chest
- Publication Type :
- Academic Journal
- Accession number :
- 34090871
- Full Text :
- https://doi.org/10.1016/j.chest.2021.05.052