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In-Hospital Mortality and Related Outcomes for Elevated Risk Acute Pulmonary Embolism Treated With Mechanical
Jennifer R Buckley1,2, Brandt C Wible1,2
124091Saint Luke's Hospital, Kansas City, MO, USA.
Journal of Intensive Care Medicine
|August 16, 2021
Summary
Mechanical thrombectomy (MT) significantly reduced in-hospital mortality and intensive care unit (ICU) length of stay for high-risk acute pulmonary embolism (PE) patients compared to routine care. Further research is warranted to confirm these findings in larger cohorts.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pulmonary Medicine
Background:
- Acute central pulmonary embolism (PE) carries significant mortality risk, particularly in elevated-risk patients.
- Current treatment strategies for high-risk PE include anticoagulation and, in select cases, advanced interventions.
- Risk stratification using Pulmonary Embolism Severity Index (PESI) and European Society of Cardiology (ESC) guidelines is crucial for guiding treatment decisions.
Purpose of the Study:
- To compare in-hospital mortality and hospitalization outcomes of elevated-risk acute central PE patients treated with mechanical thrombectomy (MT) versus routine care (RC).
- To evaluate the efficacy of the Inari FlowTriever device in managing high-risk PE patients.
Main Methods:
- Retrospective analysis of acute central PE patients stratified by PESI (4-5) and ESC (intermediate-high/high risk) scores.
- Comparison between patients treated with MT (Inari FlowTriever) and RC (primarily systemic anticoagulation).
- Primary endpoint: in-hospital mortality. Secondary endpoints: ICU length of stay, total hospital length of stay, and 30-day readmission.
Main Results:
- Mechanical thrombectomy (MT) group (n=28) showed significantly lower in-hospital mortality (3.6%) compared to the routine care (RC) group (n=30) (23.3%) (P < .05).
- MT also resulted in a significantly shorter average ICU length of stay (2.1 days) versus RC (6.1 days) (P < .05).
- Total hospital length of stay and 30-day readmission rates were comparable between the two groups.
Conclusions:
- Mechanical thrombectomy (MT) appears to improve in-hospital survival and reduce ICU stay for high-risk acute central pulmonary embolism (PE) patients.
- These findings suggest MT is a promising treatment option for selected PE patients with elevated risk profiles.
- Further prospective studies are recommended to validate these initial retrospective findings.
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