Outcomes with catheter-directed thrombolysis vs. catheter-directed embolectomy among patients with high-risk pulmonary embolism: a nationwide analysis

Abstract

Objective To examine the clinical outcomes with catheter-directed thrombolysis (CDT) vs. catheter-directed embolectomy (CDE) for high-risk pulmonary embolism (PE). Background Comparative data on the short-term outcomes for CDE vs. CDT among patients with high-risk PE are scarce. Methods The Nationwide Readmissions Database was utilized to identify hospitalizations with high-risk PE undergoing CDE or CDT from 2016 to 2019. The main outcome of interest was all-cause in-hospital mortality. Propensity score matching was used to compare the outcomes in both groups. Results Among 3,216 high-risk PE hospitalizations undergoing catheter-directed interventions, 868 (27%) received CDE, 1,864 (58%) received CDT and 484 (15%) received both procedures. In the unadjusted analysis, the rate of all-cause in-hospital mortality was not between both CDE and CDT (39.6% vs. 34.2%, P = 0.07). After propensity score matching, CDE was not associated with higher mortality (adjusted odds ratio [OR] 1.28, 95% confidence interval [CI] 0.95, 1.72, P = 0.10), intracranial hemorrhage (ICH) (adjusted OR 1.57, 95% CI 0.75, 3.29, P = 0.23) or non-ICH bleeding (adjusted OR 1.17, 95% CI 0.85, 1.62, P = 0.33). There were no differences in the length of stay, cost and 30-day unplanned readmissions between both groups. Conclusions In this contemporary observational analysis of patients admitted with high-risk PE undergoing CDT or CDE, the rates of in-hospital mortality, ICH and non-ICH bleeding events were not different.

Catheter-directed mechanical aspiration thrombectomy in a real-world pulmonary embolism population: a multicenter registry

“…Over the last decade, the role of endovascular therapies in the management of acute pulmonary embolism (PE) has rapidly evolved. 1–6 Catheter-directed thrombolysis and catheter-directed mechanical thrombectomy (CDMT) techniques have been developed to counter the bleeding risk associated with systemic thrombolysis (ST). 3 , 7–9 While CDMT for the treatment of intermediate-high risk (IHR) and HR PE is becoming increasingly implemented, data supporting its safety, and efficacy have been limited.…”

Initial results of investigator initiated international database on catheter directed therapy of acute pulmonary embolism

“…Recent analysis of over 3000 HRPE patient from The Nationwide Readmissions Database showed that 27% received mechanical CDT, 58% local thrombolysis, while 15% of other patients were treated with combined procedures. No differences were found in mortality rate and major bleedings between these groups [ 22 ].…”

Trends and outcomes of lytic-based therapies for high-risk pulmonary embolism: A nationwide analysis

“…Another study examined the national mortality trends and outcomes of high-risk PE in the USA, and demonstrated that the rate of in-hospital mortality in high-risk PE decreased from 48.1% in 2016 to 38.9% in 2019; however, they only included patients who had cardiogenic shock or those who received vasopressors. 18 Another study, by Geller et al, who examined the outcomes of lytic-based therapies in patients with PE in a private insurance database, demonstrated that patients who underwent CDT had lower high-risk features relative to ST; however, notably, patients who received lytic-based therapies were younger, with a mean age of 57 years old 19 compared to our study with a mean of 64 years old, which may point toward clinician tendency to treat higher-risk patients with ST relative to CDT.…”

“…Another study examined the national mortality trends and outcomes of high-risk PE in the USA, and demonstrated that the rate of in-hospital mortality in high-risk PE decreased from 48.1% in 2016 to 38.9% in 2019; however, they only included patients who had cardiogenic shock or those who received vasopressors. 18…”