Aims
Chronic thromboembolic pulmonary hypertension (CTEPH) is considered as a rare but severe sequalae after acute pulmonary embolism (PE) and is treatable by pulmonary endarterectomy (PEA) and/or Ballon pulmonary angioplasty (BPA). We aimed to evaluate, over a 10-year period, time trends of in-hospital outcomes and complications of BPA or PEA in CTEPH patients in the German nationwide inpatient sample.
Methods and Results
We analyzed data on the characteristics, comorbidities, treatments and in-hospital outcomes for all CTEPH patients treated with PEA or BPA in Germany between 2012 and 2022 (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2016-2020, and own calculations). Overall, 52,210 patients had a diagnosis of CTEPH. Of those, 2,448 were treated with PEA and 2,478 with BPA. Patients’ characteristics shifted slightly towards older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Patients with PEA were younger (61 vs 64 age) and had a longer in-hosptial stay (6 vs 3 days) comparted to patients with BPA. While BPA procedure steadily increased over the observations period (2012/2013:7 to 2022: 308; ß 2.822 [95%CI 2.671-2,9732]; p<0.001), PEA remained unchanged (2012: 148 to 2022: ; ß -0.059 [95%CI -0.231- 0.094]; p=0.448). Overall, the in-hospital case-fatality rate was low for BPA with three cases (0.1%) only. Patients underwent PEA had a considerably higher mortality rate in 119 (4.5%), with the highest fatality rate in 2012 and the lowest in 2022 with 2.1% (ß -1.994 [95%CI -2.655-1,333]; p<0.001). Severe complications as pericardial effusion (0.1%), lung oedema (0.4%), shock (0.2%) or cardiopulmonary resuscitation (0.2%) were rate, since a considerable number reported about hemoptysis (5.4%).
Conclusion
The number of CTEPH patients treated with BPA increased substantially in Germany from 2012 to 2022, while the use of PEA remained relatively stable. BPA was associated with a low in-hospital case-fatality rate, supporting its role particularly in medically fragile patients. However, attention is required regarding the risk of hemoptysis.
