Five-year survival after large-bore mechanical thrombectomy for intermediate-high and high-risk pulmonary embolism: a...

While early outcomes after catheter-directed therapies are widely described, longer-term results are not.

To evaluate short- and long-term all-cause and pulmonary embolism (PE)-related mortality in consecutive unselected patients with intermediate-high and high-risk PE treated with large-bore mechanical thrombectomy (LBT).

The first 100 consecutive patients with high- and intermediate-high-risk PE who underwent LBT at a single academic center were retrospectively analyzed. Baseline characteristics, procedural parameters, and periprocedural complications were collected from electronic records. Kaplan-Meier estimated survival in prespecified windows, whereas nonproportional Cox regression was used to establish mortality predictors at different time points.

Five-year all-cause and PE-related mortality were 34% and 9%, respectively. High-risk patients required higher oxygen needs and intubation. Periprocedural complications and short-term mortality were also greater. The intermediate-high-risk group suffered no PE-related mortality. Across the complete cohort, European Society of Cardiology severity, presence of cardiac arrest, and active malignancy emerged as time-dependent mortality predictors within the early window period. Long-term mortality was influenced by malignancy status and oxygen requirements preceding the intervention. Within the intermediate-high-risk stratum, proposed markers of subtle hemodynamic compromise failed to predict mortality.

These real-world outcomes provide context to PE trials by reflecting a single-center first experience with LBT. Despite the substantially reduced survival at 5 years in both groups, intermediate-high-risk patients suffered no PE-related mortality. Long-term mortality was largely influenced by active malignancy and oxygenation needs at presentation.