Abstract | BACKGROUND: RESEARCH QUESTION: What are the differences in baseline characteristics and 1-year outcomes between operated and nonoperated subjects? 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. 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). 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. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT02429284; URL: www.clinicaltrials.gov.
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Authors | Kim M Kerr, C Greg Elliott, Kelly Chin, Raymond L Benza, Richard N Channick, R Duane Davis, Feng He, Andrea LaCroix, Michael M Madani, Vallerie V McLaughlin, Myung Park, Ivan M Robbins, Victor F Tapson, Jeffrey R Terry, Victor J Test, Sonia Jain, William R Auger |
Journal | Chest
(Chest)
Vol. 160
Issue 5
Pg. 1822-1831
(11 2021)
ISSN: 1931-3543 [Electronic] United States |
PMID | 34090871
(Publication Type: Journal Article, Multicenter Study, Observational Study)
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Copyright | Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved. |
Chemical References |
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Topics |
- Antihypertensive Agents
(therapeutic use)
- Conservative Treatment
(methods, statistics & numerical data)
- Endarterectomy
(adverse effects, methods, statistics & numerical data)
- Female
- Functional Status
- Humans
- Hypertension, Pulmonary
(epidemiology, etiology, physiopathology, therapy)
- Longitudinal Studies
- Male
- Middle Aged
- Outcome and Process Assessment, Health Care
- Oxygen Inhalation Therapy
(methods, statistics & numerical data)
- Pulmonary Embolism
(complications, diagnostic imaging, surgery)
- Pulmonary Wedge Pressure
- Registries
- Risk Assessment
- Risk Factors
- United States
(epidemiology)
- Vascular Resistance
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