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Published on: October 25, 2024
Mechanical Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolism: A Risk-Stratified, Propensity
Fouad Hanna1, Ahmed Abdelmaksoud2, Ali Dway3
1Faculty of Medicine, Cairo University, Giza, Egypt.
Summary
Mechanical thrombectomy (MT) reduced 1-year mortality in intermediate-risk pulmonary embolism (PE), but benefits varied by risk subgroup. High-intermediate risk PE saw survival gains, while low-intermediate risk PE experienced increased pulmonary hypertension and right heart failure with MT.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Interventional Radiology
Background:
- The survival advantage of mechanical thrombectomy (MT) versus anticoagulation (AC) for intermediate-risk pulmonary embolism (PE) is not well-established.
- Differences in MT benefits across PE risk subgroups require further investigation.
Purpose of the Study:
- To compare 1-year all-cause mortality and long-term cardiopulmonary outcomes between MT and AC in intermediate-risk PE patients.
- To analyze outcomes stratified by low-intermediate (AHA/ACC PE Category C1-C2) and high-intermediate (AHA/ACC PE Category C3) risk subgroups.
Main Methods:
- Retrospective, propensity score-matched cohort study utilizing the TriNetX Analytics Network (2010-2026).
- Adult patients with acute PE were categorized into low-intermediate and high-intermediate risk groups.
- Primary endpoint: 365-day all-cause mortality. Secondary endpoints: pulmonary hypertension, right heart failure, acute respiratory failure, and bleeding.
Main Results:
- MT was associated with significantly lower 1-year all-cause mortality in both low-intermediate risk (11.0% vs. 17.8%) and high-intermediate risk (7.0% vs. 11.0%) PE.
- In low-intermediate risk PE, MT increased the risk of pulmonary hypertension (HR 1.578) and right heart failure (HR 4.473).
- In high-intermediate risk PE, MT reduced the risk of pulmonary hypertension (HR 0.764) and bleeding (HR 0.744).
Conclusions:
- Mechanical thrombectomy (MT) demonstrates reduced 1-year mortality in intermediate-risk pulmonary embolism (PE) compared to anticoagulation (AC) alone.
- The net clinical benefit of MT is risk-profile dependent, appearing favorable in high-intermediate risk PE but offset by adverse cardiopulmonary events in low-intermediate risk PE.
- Findings are hypothesis-generating and necessitate validation through adequately powered randomized controlled trials.
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