Catheter-based therapy for high-risk or intermediate-risk pulmonary embolism: death and re-hospitalization

Orly Leiva; Carlos Alviar; Sameer Khandhar; Sahil A Parikh; Catalin Toma; Radu Postelnicu; James Horowitz; Vikramjit Mukherjee; Allison Greco; Sripal Bangalore

doi:10.1093/eurheartj/ehae184

Catheter-based therapy for high-risk or intermediate-risk pulmonary embolism: death and re-hospitalization

Eur Heart J. 2024 Apr 4:ehae184. doi: 10.1093/eurheartj/ehae184. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY 10016, USA.
² Division of Cardiology, Penn Presbyterian Medical Center, Philadelphia, PA, USA.
³ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Division of Cardiology, Columbia University Irving Medical School, New York-Presbyterian Hospital, New York, NY, USA.
⁵ Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁶ Department of Medicine, Division of Pulmonology and Critical Care, New York University Grossman School of Medicine, New York, NY, USA.

PMID: 38573048
DOI: 10.1093/eurheartj/ehae184

Abstract

Background and aims: Catheter-based therapies (CBTs) have been developed as a treatment option in patients with pulmonary embolism (PE). There remains a paucity of data to inform decision-making in patients with intermediate-risk or high-risk PE. The aim of this study was to characterize in-hospital and readmission outcomes in patients with intermediate-risk or high-risk PE treated with vs. without CBT in a large retrospective registry.

Methods: Patients hospitalized with intermediate-risk or high-risk PE were identified using the 2017-20 National Readmission Database. In-hospital outcomes included death and bleeding and 30- and 90-day readmission outcomes including all-cause, venous thromboembolism (VTE)-related and bleeding-related readmissions. Inverse probability of treatment weighting (IPTW) was utilized to compare outcomes between CBT and no CBT.

Results: A total of 14 903 [2076 (13.9%) with CBT] and 42 829 [8824 (20.6%) with CBT] patients with high-risk and intermediate-risk PE were included, respectively. Prior to IPTW, patients with CBT were younger and less likely to have cancer and cardiac arrest, receive systemic thrombolysis, or be on mechanical ventilation. In the IPTW logistic regression model, CBT was associated with lower odds of in-hospital death in high-risk [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.80-0.87] and intermediate-risk PE (OR 0.76, 95% CI 0.70-0.83). Patients with high-risk PE treated with CBT were associated with lower risk of 90-day all-cause [hazard ratio (HR) 0.77, 95% CI 0.71-0.83] and VTE (HR 0.46, 95% CI 0.34-0.63) readmission. Patients with intermediate-risk PE treated with CBT were associated with lower risk of 90-day all-cause (HR 0.75, 95% CI 0.72-0.79) and VTE (HR 0.66, 95% CI 0.57-0.76) readmission.

Conclusions: Among patients with high-risk or intermediate-risk PE, CBT was associated with lower in-hospital death and 90-day readmission. Prospective, randomized trials are needed to confirm these findings.

Keywords: Catheter-based therapy; Catheter-directed thrombolysis; Percutaneous mechanical thrombectomy; Pulmonary embolism; Venous thromboembolism.

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.