Clinical Outcomes following Mechanical Thrombectomy in Pulmonary Embolism Response Team-Consulted Patients: A Retrospective Analysis

Abstract

Purpose: To determine if use of mechanical thrombectomy (MT) impacts survival and additional outcomes in patients with acute intermediate-high-risk and high-risk pulmonary embolism (PE) who were evaluated by a Pulmonary Embolism Response Team (PERT).

Methods: This retrospective, single-center study included patients with intermediate-high-risk and high-risk PE who received PERT evaluation over 3.5 years and were treated with anticoagulation (AC) alone or MT + AC. The primary outcome was 30-day all-cause mortality, measured with inverse probability of treatment weighting. Exploratory outcomes included survival during the study period, PE-associated/caused mortality, hospital length of stay (LOS), supplemental oxygen at discharge, and MT-related metrics.

Results: Of 335 patients, 259 received AC alone and 76 received MT + AC. The use of MT was associated with reduced odds of 30-day all-cause mortality (odds ratio, 0.49; 95% CI, 0.27-0.76; P = .002). There were no significant differences in PE-associated/caused mortality. Hospital LOS was 2 days shorter in the MT + AC cohort (P < .001). Of patients receiving MT + AC, those with high-risk PE had a 4.5-day shorter stay (P < .001), whereas those with intermediate-high-risk PE had a 2-day shorter stay (P < .001). The proportion of patients receiving supplemental oxygen at discharge was lower in the MT + AC group (MT + AC vs AC, 4.1% vs 18.5%; P < .001), without significant differences in 30-day readmission rates (MT + AC vs AC, 9.5% vs 20.6%; P = .115). MT resulted in an 8.7-mm Hg reduction in mean pulmonary artery pressure, had a technical success rate of 100% (76 of 76), and an adverse event rate of 6.6% (5 of 76).

Conclusions: MT reduced 30-day all-cause mortality, hospital LOS, and supplemental oxygen at discharge in the intermediate-high-risk and high-risk PE population.