الفهرس 
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Abstract
This Interventional prospective case–control study was conducted after the approval of the Scientific Ethics Committee of Faculty of Medicine of Assiut University.
The place of the study was Assiut University Hospital including Emergency department, Cardiology department, and Pulmonology department.
Among the patients admitted to the emergency department during the period from December 2018 to January 2021, our team confirmed the diagnosis of PE in 166 patients. One hundred and sixteen patients were excluded (92 patients with low- or intermediate-low-risk PE and remaining 24 patients refused to be included in the study). We recruited 50 patients with confirmed acute high- or intermediate-high-risk. Informed consent to deal with the patient’s data for scientific purposes was obtained from the patients or persons accompanying them. . Patients were then classified into two groups based on the following protocol. Once patient is accepted in the study, the team decide if there is a contraindication or not for systemic thrombolysis. If no contraindication for systemic thrombolysis, patients were included in group B and received systemic thrombolysis and reassessed after 24–48 hours for the response. But if there was any contraindication for or failed management with ST, patients were included in group A and transferred to cardiology catheterization laboratory for catheter directed fragmentation of the thrombus.
The aim of our study was to evaluate the safety and efficacy of CDI in comparison with systemic thrombolysis, and to further compare the in-hospital outcomes between catheter directed interventions
and systemic thrombolysis.
At the end of the study, we reported the following results:
1. The most frequent risk factor for pulmonary embolism among both CDI and ST group was major surgery 24 % and 40 % respectively and fracture 24% and 12% respectively.
2. The most frequent finding by CTPA chest on admission was bilateral main PE, 21% in CDI group and 17% in ST group.
3. The most common clinical presentation was acute dyspnea as it was present in 96% of patients, followed by chest pain that was present in 78% of patients. Hemoptysis was found in 36% of patients while 24% complained of cough and 32% had signs of DVT as leg swelling and pain. 50% of patients were hemodynamically unstable.
4. There were significantly higher differences in the mean of systolic blood pressure in CDI group when compared to ST group after 24 h (p= 0.024), after 48h (p<0.001) and after 30 days (p= 0.033), however, the changed increase in systolic blood pressure after 48 h was higher in CDI group when compared to ST group (p= 0.007).
5. There was a significant higher difference in diastolic blood pressure of CDI group when compared to ST group after 24 h (p= 0.003), and after 48h (p<0.001), However the changed increase in diastolic blood pressure after 48 h was higher in CDI group when compared to ST group (p= 0.023).
6. There were no significant differences in the mean pulmonary artery systolic pressure between CDI and ST group after 48 h and 30 days, however the changed DROP in PASP was higher in CDI group compared with ST group after 48 h and 30 days (p<0.001).
7. There were significant differences in the mean respiratory rate between CDI and ST group after 48 h (p= 0.013) and 30 days (p= 0.004), however the changed DROP in RR was higher in CDI group compared with ST group after 48 h (p=0.008).
8. There was significantly higher in CDI group when compared to ST group after 30 days (p= 0.025), and the changed increase in oxygen saturation after 24 h, 48 h and 30 days was higher in CDI group when compared to ST group (p<0.001).
9. There were no significant differences in the mean heart rate between CDI and ST group after 24 h, 48 h and 30 days, however the changed DROP in HR was higher in CDI group compared with ST group after 48 h (p=0.008).
10. There was a significant difference in the mean shock index between CDI and ST group after 48 h (p= 0.001).
11. As regard to the mortality in hospital there was no significant differences between patients underwent CDI versus systemic thrombolysis, also there was no significant differences between both groups in 30-day mortality outcome.
12. There was no difference between both groups as regard to the occurrence of complications.