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Wiedenroth CB, Rolf A, Steinhaus K, Adameit MSD, Kriechbaum SD, Haas M, Roller F, Hamm CW, Ghofrani HA, Mayer E, Breithecker A, Guth S, Liebetrau C. Riociguat and balloon pulmonary angioplasty improve prognosis in patients with inoperable chronic thromboembolic pulmonary Hypertension. J Heart Lung Transplant 2023; 42:134-139. [PMID: 36257870 DOI: 10.1016/j.healun.2022.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/25/2022] [Accepted: 08/17/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The combination of riociguat and interventional balloon pulmonary angioplasty (BPA) is currently used to treat patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). The aim of the present study was to evaluate the impact of this combination therapy on the prognosis of inoperable CTEPH patients by comparing the long-term survival rates of patients undergoing combination therapy with riociguat and BPA with those of inoperable patients from the first international CTEPH registry who did not receive specific treatment. METHODS Between March 2014 and August 2019, 138 technically inoperable patients were included in the present prospective, observational cohort study when they were treated with riociguat and BPA at a single CTEPH referral center. Long-term survival of this cohort was compared using propensity score matching with that of inoperable patients recruited between 2007 and 2009 in the first international CTEPH registry. Kaplan-Meier methods were used to evaluate differences in outcomes. RESULTS Whereas the survival rate in the historical group was 84.6% in the first year, 76.6% in the second, 68.5% in the third, and 58.5% in the fifth year after diagnosis, implementation of riociguat/BPA led to survival rates of 100%, 96.7%, 92.9%, and 90% in the respective follow-up periods. In a comparison of 83 well-matched pairs from the 2 cohorts, survival was markedly better in the group treated with riociguat and BPA than in the historical cohort (HR = 0.145, 95% CI 0.05, 0.421). CONCLUSION The combination of riociguat and BPA for the treatment of inoperable CTEPH is associated with excellent 5-year survival rates.
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Affiliation(s)
| | - Andreas Rolf
- Kerckhoff Heart and Lung Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), partner site RheinMain, Bad Nauheim, Germany
| | - Kristin Steinhaus
- University of Göttingen, Department of Cardiology and Pneumology, Göttingen, Germany
| | - Miriam S D Adameit
- Kerckhoff Heart and Lung Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Steffen D Kriechbaum
- Kerckhoff Heart and Lung Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), partner site RheinMain, Bad Nauheim, Germany
| | - Moritz Haas
- Kerckhoff Heart and Lung Center, Department of Cardiology, Bad Nauheim, Germany
| | - Fritz Roller
- University of Giessen, Department of Radiology, Giessen, Germany
| | - Christian W Hamm
- Kerckhoff Heart and Lung Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), partner site RheinMain, Bad Nauheim, Germany; University of Giessen, Department of Internal Medicine I, Division of Cardiology, Giessen, Germany
| | - H Ardeschir Ghofrani
- Kerckhoff Heart and Lung Center, Department of Pulmonology, Bad Nauheim, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL); Department of Medicine, Imperial College London, UK
| | - Eckhard Mayer
- Kerckhoff Heart and Lung Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Andreas Breithecker
- Kerckhoff Heart and Lung Center, Department of Radiology, Bad Nauheim, Germany; Gesundheitszentrum Wetterau, Department of Radiology, Bad Nauheim, Germany
| | - Stefan Guth
- Kerckhoff Heart and Lung Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Kerckhoff Heart and Lung Center, Department of Cardiology, Bad Nauheim, Germany; Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
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