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Catheter-Based Therapy for High- or Intermediate-Risk PE
Quick Takes
- Among patients with high-risk or intermediate-risk PE, catheter-based therapy was associated with a reduced risk of in-hospital death.
- The current study has limitations intrinsic to using an administrative database that should be considered when interpreting its results.
- Studies also need to assess benefits of catheter-directed thrombolysis and mechanical thrombectomy individually compared to systemic thrombolysis.
Study Questions:
What are the in-hospital and readmission outcomes in patients with intermediate-risk or high-risk pulmonary embolism (PE) treated with versus without catheter-based therapies (CBTs) in a large retrospective registry?
Methods:
The investigators identified patients hospitalized with intermediate-risk or high-risk PE 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. For in-hospital outcomes, IPTW logistic regression was employed to estimate the odds ratio (OR) and 95% confidence interval (CI). Time-to-event analysis using Cox proportional hazard regression modeling to estimate hazard ratio (HR) and 95% CI of 90-day readmission was used before and after IPTW.
Results:
A total of 14,903 (2,076 [13.9%] with CBT) and 42,829 (8,824 [20.6%] with CBT) patients with high- 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 (OR, 0.83; 95% CI, 0.80-0.87) and intermediate-risk (OR, 0.76; 95% CI, 0.70-0.83) PE. Patients with high-risk PE treated with CBT were associated with lower risk of 90-day all-cause (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:
The authors report that among patients with high- or intermediate-risk PE, CBT was associated with lower in-hospital death and 90-day readmission.
Perspective:
This registry study reports that among patients with high- or intermediate-risk PE, CBT is associated with a reduced risk of in-hospital death. Furthermore, patients treated with CBT showed a lower risk of 90-day all-cause and VTE-related readmissions. The current study has limitations intrinsic to using an administrative database that should be considered when interpreting its results. Additional prospective randomized trials are needed, in order to validate these findings. In addition, studies need to assess benefits of catheter-directed thrombolysis and mechanical thrombectomy individually compared to systemic thrombolysis.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Interventions and Vascular Medicine
Keywords: Pulmonary Embolism, Thrombectomy, Thrombolytic Therapy
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