Short and long-term outcomes of intermediate-high risk pulmonary embolism treated with catheter-directed reperfusion...

Treatment of intermediate-high risk pulmonary embolism (PE) with catheter directed therapy remains a topic of controversy. It is unknown if long-term post-hospitalization outcomes of these patients are improved compared to anticoagulation.

What is the comparative effectiveness of catheter-directed reperfusion therapy versus conventional anticoagulation on both short- and long-term outcomes among patients with intermediate-high risk PE?

This was a retrospective cohort study of hospitalized patients in the United States with intermediate-high risk pulmonary embolism between 2010 and 2024 from a multi-institutional aggregated electronic health record database. Patients were categorized as receiving catheter-directed intervention (CDI) or conventional anticoagulation and followed for 30-day mortality, bleeding and procedural complications (short-term outcomes) and, among those who survived discharge, for readmission related to heart failure or respiratory failure, oxygen dependence, and pulmonary hypertension related diagnosis (long-term outcomes). Overlap weighting was used to balance characteristics between patients in both groups and weighted hazard ratios were calculated.

After application of a specific phenotype definition integrating diagnosis codes, vital signs, and laboratory biomarkers to identify patients with intermediate high-risk PE in a large-scale data set, a total of 50,614 patients were included in the analysis of short-term outcomes and 49,122 were included in the analysis of post-discharge outcomes. CDI was associated with a lower hazard of death in both crude (HR 0.56; 95% CI 0.53-0.59, p < 0.001) and adjusted comparisons (aHR 0.70; 95% CI 0.66-0.73, p < 0.001). Although there was no increase in CTEPH rates (aHR 1.05; 95% CI 1.00-1.10, p = 0.057), long-term outcomes favored CDI including lower rates of readmission for heart failure (aHR 0.79; 95% CI 0.75-0.83, p < 0.001), readmission for respiratory failure (aHR 0.85; 95% CI 0.81-0.90, p < 0.001), and lower chronic oxygen usage (aHR 0.69; 95% CI 0.65-0.74, p < 0.001).

Among patients with intermediate-high risk pulmonary embolism, CDI was associated with improved short- and long-term survival compared to anticoagulation alone. These findings suggest a potential benefit of CDI in intermediate-high risk PE and support the need for randomized trials powered for long-term, patient-centered outcomes.