Racial disparities in patient outcomes following catheter-directed thrombectomy for acute pulmonary embolism

Acute pulmonary embolism (PE) is a leading cause of cardiovascular morbidity and mortality, with in-hospital mortality approaching 30% in high-risk presentations. Catheter-directed thrombectomy (CDT) is increasingly used as advanced reperfusion but carries meaningful peri‑procedural risk. Contemporary data on racial disparities following CDT remain limited.

Using the Nationwide Inpatient Sample (2016-2022), adults hospitalized with PE undergoing CDT were identified and stratified by race (White, Black, Hispanic, Asian/Pacific Islander[PI], Native American). Inverse probability of treatment weighting using a multinomial propensity score model was applied, followed by weighted logistic regression. The primary endpoint was net adverse clinical events (NACE), defined as mortality, stroke, or major bleeding. Secondary outcomes included other in-hospital complications.

Compared with White patients, adjusted odds of NACE were higher among Black (OR 1.14; P = 0.045), Hispanic (OR 1.58; P < 0.001), Asian/PI (OR 1.69; P = 0.034), and Native American patients (OR 3.03; P = 0.015). Asian patients had higher mortality (OR 2.00; P = 0.041). Major bleeding was more frequent in Black (OR 1.18; P = 0.034), Hispanic (OR 1.32; P = 0.040), and Native American patients (OR 3.38; P = 0.008). Black and Hispanic patients had higher transfusion and ventilation rates (all P < 0.01).

Significant racial disparities in NACE, mortality, and bleeding were observed following CDT for acute PE. Native American patients showed numerically higher NACE, Asian/PI patients had the highest mortality, and Black patients had higher bleeding. Residual confounding by PE severity cannot be excluded given absent severity markers in the NIS. Findings highlight the need for equity-focused risk stratification and standardized peri‑procedural strategies in advanced PE.