Survival Rates With Parenteral Prostanoids in Pulmonary Arterial Hypertension

In patients with pulmonary arterial hypertension (PAH) who received a parenteral prostanoid and were undergoing a posttreatment evaluation, the best survival rates were observed in those who attained multiple lower-risk European Society of Cardiology/European Respiratory Society (ESC/ESR) consensus guideline criteria, according to the results of a retrospective cohort study published in Chest.

The investigators sought to assess transplant-free survival in patients with group 1 PAH being treated with intravenous (IV) epoprostenol or IV or subcutaneous (SC) treprostinil between 2007 and 2016 at either the University of Texas Southwestern in Dallas or the Ohio State University in Columbus. Survival was evaluated from the time of IV/SC treatment initiation and from the time of the first follow-up. Utility of traditional prognostic measures was evaluated using the categories (lower risk, intermediate risk, higher risk) recommended in the 2015 ESC/ESR guidelines for the following: functional class, 6-minute walk distance (6MWD), brain natriuretic peptide (BNP) or N-terminal BNP (NT-proBNP) level, and hemodynamic results. 

Overall, 132 patients who received IV epoprostenol, 25 patients who received IV treprostinil, and 38 patients who received SC treprostinil were included in the study. Survival rates from the time of IV/SC prostanoid initiation were 84%, 77%, and 67% at 1 year, 2 years, and 3 years, respectively.

In 163 patients, follow-up assessment was conducted after a minimum of 90 days’ therapy (mean, 356±247 days). Significantly improved functional class (P <.001), 6MWD (P <.001), BNP or NT-proBNP (P <.001), and mixed venous oxygen saturation (P <.001), but not cardiac index, were associated with survival following treatment with IV/SC prostanoid, as were the total number of lower-risk and higher-risk findings (P <.001). The presence of 0 lower-risk findings or ≥2 higher-risk findings was related to particularly poor outcomes, with 2-year survival rates of <50%.

The investigators concluded that in patients with PAH who received continuous prostanoid treatment, survival was linked significantly to the number of guideline-recommended lower-risk and higher-risk criteria attained at first follow-up.

Reference

Bartolome SD, Sood N, Shah TS, Styrvoky K, Torres FT, Chin KM. Mortality in pulmonary arterial hypertension patients treated with continuous prostanoids [published online April 18, 2018]. Chest. doi:10.1016/j.chest.2018.03.050