Percutaneous mechanical thrombectomy in acute pulmonary embolism: Outcomes from a safety-net hospital

Area of Science:

• Cardiology
• Pulmonary Medicine
• Interventional Radiology

Background:

• Mechanical thrombectomy (MT) is an emerging treatment for acute pulmonary embolism (PE).
• Safety-net hospitals serve vulnerable populations with unique healthcare challenges.
• Clinical outcomes of MT in safety-net settings are not well-established.

Purpose of the Study:

• To evaluate the clinical outcomes of mechanical thrombectomy (MT) in patients with intermediate or high-risk pulmonary embolism (PE).
• To assess the safety and efficacy of MT in a safety-net hospital population.
• To examine the impact of MT on hemodynamic parameters and mortality rates.

Main Methods:

• Retrospective study of 61 intermediate or high-risk PE patients undergoing MT.
• Data collected from October 2020 to May 2023.
• Primary outcome: 30-day mortality. Secondary outcomes: hemodynamic changes, all-cause mortality.

Main Results:

• The cohort (62.3% Medicaid/uninsured, 50.8% high poverty zip code) showed immediate hemodynamic improvements, including a mean pulmonary artery pressure drop of 7.4 mmHg and 93% cardiac index normalization.
• Overall 30-day mortality was 5%, with 0% mortality in the intermediate-risk group. All deaths occurred in patients presenting with cardiac arrest.
• No significant differences in short-term mortality were observed based on race, insurance, or socioeconomic status.

Conclusions:

• Mechanical thrombectomy (MT) demonstrates a favorable safety profile and efficacy in managing acute pulmonary embolism (PE) patients within a safety-net hospital.
• The procedure leads to immediate hemodynamic improvements and low 30-day mortality, even in a high-risk and vulnerable patient population.
• Findings support the use of MT as a viable treatment option for PE in diverse and underserved communities.