VALUE OF PULMONARY VASCULAR OBSTRUCTION INDEX FOR DETERMINING THROMBOLYTIC THERAPY

MURAT GÜ ZEL*, AYŞEGÜL İDIL SOYLU**, ÖMER SALT *** , ALI KEMAL ERENLER****, LEMAN TOMAK*****, ESRA ARSLAN AKSU******, ERDI ATAY*, AHMET BAYDIN*******

*Samsun Training and Research Hospital Department of Emergency MedicineSamsun, Turkey - **Department of Radiology, Ondokuzmayis University, Samsun, Turkey - ***Department of Emergency Medicine, Trakya University, Edirne, Turkey - ****Department of Emergency Medicine, Hitit University, Çorum, Turkey - *****Department of Medical Biostatistics, Ondokuz Mayis University, Samsun, Turkey - ******Samsun Training and Research Hospital Department of Chest Disease Samsun, Turkey *******Prof. Department of Emergency Medicine, Ondokuzmayıs University, Samsun, Turkey

Introduction: An index for Pulmonary Artery Computed Tomography Index Ratio (PACTOIR) may have important prognostic and therapeutic implications and as well as providing a standard to evaluate thrombolytic therapy response. The aim of this study was to determine whether PACTOIR predict the thrombolytic therapy in the treatment of pulmonary embolism (PE).

Materials and methods: This retrospective study was conducted by reviewing charts of 52 patients (aged ≥18 years) who were admitted to our emergency department (ED) with initial diagnosis of pulmonary embolism and confirmed diagnosis of PE by Computed Tomography Pulmonary Angiography (CPTA). The patients were divided into two groups as follows: Group 1 (n=14) consisted of the patients who received thrombolytic therapy and Group 2 (n=38) consisted of the patients who did not receive thrombolytic therapy. PACTOIR was calculated in both groups to estimate thrombus load. We evaluated the effectiveness of thrombolytic therapy by comparing the levels of D-dimer and Troponin I.

Results: Mean value for PACTOIR, D-dimer and Troponin I levels were 56.4 (%), 6.21 (mg/L) and 0.35 (μg/L) in Group 1 whereas they were 20.46 (%), 2.20 (mg/L) and 0.11 (μg/L) in Group 2, respectively. Significant difference was detected between Group 1 and Group 2 (p<0.001). The sensitivity and specificity values were calculated as 92.9% and 89.5% for PACTOIR, whereas they were 85.7% and 78.9% for D-dimer, respectively. These values were found to be 78.6% and 65.8% for Troponin I, respectively.

Conclusion: Based on our results, sensitivity to show PE severity and to determine thrombolytic therapy was significant when compared to D-dimer and Troponin I. In addition, we concluded that PACTOIR is the parameter with greatest sensitivity in determining the effectiveness of thrombolytic therapy.