Worldwide CTEPH Registry: Long-Term Outcomes With Pulmonary Endarterectomy, Balloon Pulmonary Angioplasty, and Medical Therapy

被引:12
作者
Delcroix, Marion [1 ,2 ]
Pepke-Zaba, Joanna [3 ]
D'Armini, Andrea M. [4 ,5 ,6 ]
Fadel, Elie [7 ]
Guth, Stefan [8 ]
Hoole, Stephen P. [3 ]
Jenkins, David P. [3 ]
Kiely, David G. [9 ,10 ]
Kim, Nick H. [11 ]
Madani, Michael M. [12 ]
Matsubara, Hiromi [13 ]
Nakayama, Kazuhiko [14 ]
Ogawa, Aiko [13 ]
Ota-Arakaki, Jaquelina S. [15 ,16 ]
Quarck, Rozenn [1 ,2 ]
Sadushi-Kolici, Roela [17 ]
Simonneau, Gerald [18 ,19 ]
Wiedenroth, Christoph B. [8 ]
Yildizeli, Bedrettin [20 ]
Mayer, Eckhard [8 ]
Lang, Irene M. [17 ]
机构
[1] Univ Hosp Leuven, Clin Dept Resp Dis, Leuven, Belgium
[2] Univ Leuven, Dept Chron Dis & Metab, Lab Resp Dis & Thorac Surg, B-3000 Leuven, Belgium
[3] Royal Papworth Hosp, Cambridge, England
[4] Fdn IRCCS Policlin San Matteo, Div Cardiac Surg 2, Pavia, Italy
[5] Fdn IRCCS Policlin San Matteo, Chron Thromboembol Pulm Hypertens Ctr, Cardiothorac & Vasc Dept, Pavia, Italy
[6] Univ Pavia, Sch Med, Pavia, Italy
[7] Paris Saclay Univ, Marie Lannelongue Hosp, Dept Thorac & Vasc Surg & Heart Lung Transplantat, Le Plessis Robinson, France
[8] Kerckhoff Heart & Lung Ctr, Dept Thorac Surg, Bad Nauheim, Germany
[9] Sheffield Teaching Hosp NHS Fdn Trust, Royal Hallamshire Hosp, Sheffield Pulm Vasc Dis Unit, Sheffield, S Yorkshire, England
[10] Sheffield Teaching Hosp NHS Fdn Trust, Royal Hallamshire Hosp, Sheffield Pulm Vasc Dis Unit, Sheffield, S Yorkshire, England
[11] Univ Calif San Diego, Div Pulm & Crit Care Med, La Jolla, CA USA
[12] Univ Calif San Diego, Cardiovasc & Thorac Surg, La Jolla, CA USA
[13] Natl Hosp Org Okayama Med Ctr, Okayama, Japan
[14] Kobe Univ, Grad Sch Med, Dept Internal Med, Div Cardiovasc Med, Kobe, Hyogo, Japan
[15] Univ Fed Sao Paulo Unifesp, Dept Med, Sao Paulo, SP, Brazil
[16] Univ Fed Sao Paulo, Univ Hosp Escola Paulista Med, Hosp Sao Paulo, Div Resp Dis,Pulm Funct & Exercise Physiol Unit, Sao Paulo, Brazil
[17] Med Univ Vienna, Dept Internal Med 2, Div Cardiol, Vienna, Austria
[18] Univ Paris Sud, Hop Bicetre, AP HP, Serv Pneumol,Lab Excellence Rech Medicament & Inn, Le Kremlin Bicetre, France
[19] Inst Natl St & Rech Med, Unite 999, Le Kremlin Bicetre, France
[20] Marmara Univ, Sch Med, Dept Thorac Surg, Istanbul, Turkiye
关键词
angioplasty; balloon; endarterectomy; hypertension; pulmonary; registries; venous thromboembolism; HYPERTENSION; PROGNOSIS; RIOCIGUAT; PATIENT;
D O I
10.1161/CIRCULATIONAHA.124.068610
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND:The European Chronic Thromboembolic Pulmonary Hypertension (CTEPH) registry, conducted between 2007 and 2012, reported the major impact of pulmonary endarterectomy (PEA) on the long-term survival of patients with CTEPH. Since then, 2 additional treatments for inoperable CTEPH have become available: balloon pulmonary angioplasty (BPA), and an approved oral drug therapy with the guanylate cyclase stimulator riociguat. The current registry aimed to evaluate the effect of these new therapeutic approaches in a worldwide context. METHODS:Participation in this international global registry included 34 centers in 20 countries. Between February 2015 and September 2016, 1009 newly diagnosed, consecutive patients were included and followed until September 2019. RESULTS:Overall, 605 patients (60%) underwent PEA and 185 (18%) underwent BPA; 76% of the 219 remaining patients not receiving mechanical intervention (ie, neither PEA nor BPA) were treated with pulmonary hypertension drugs. Of patients undergoing PEA and BPA, 38% and 78% also received drugs for pulmonary hypertension, respectively. Median age at diagnosis was higher in the BPA and No PEA/BPA groups than in the PEA group: 66 and 69, respectively, versus 60 years. Pulmonary vascular resistance (PVR) was similar in all groups, with an average of 643 dynes.s.cm(-5). During the observation period (>3 years; <= 5.6 years), death was reported in 7%, 11%, and 27% of patients treated by PEA and BPA, and those receiving no mechanical intervention (P<0.001). In Kaplan-Meier analysis, 3-year survival was 94%, 92%, and 71% in the 3 groups, respectively. PEA 3-year survival improved by 5% from that observed between 2007 and 2012. There was no survival difference in patients receiving vitamin K antagonists and non-vitamin K oral anticoagulants (P=0.756). In Cox regression, reduced mortality was associated with: PEA and BPA in the global cohort; history of venous thromboembolism and lower PVR in the PEA group; lower right atrial pressure in the BPA group; and use of pulmonary hypertension drugs, oxygen therapy, and lower right atrial pressure, as well as functional class in the group receiving no mechanical intervention. CONCLUSIONS:This second international CTEPH registry reveals important improvement in patient survival since the introduction of BPA and an approved drug for pulmonary hypertension. The type of anticoagulation regimen did not influence survival.
引用
收藏
页码:1354 / 1365
页数:12
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