Outcomes with catheter-directed thrombolysis vs. catheter-directed embolectomy among patients with high-risk pulmonary embolism: a nationwide analysis

Sedhom, Ramy; Elbadawi, Ayman; Megaly, Michael; Athar, Ahmed; Bharadwaj, Aditya S; Prasad, Vinoy; Cameron, Scott J; Weinberg, Ido; Mamas, Mamas A; Messerli, Adrian W; Jaber, Wissam; Elgendy, Islam Y

Abstract

Aims To examine the shot-term outcomes with catheter-directed thrombolysis (CDT) vs. catheter-directed embolectomy (CDE) for high-risk pulmonary embolism (PE). Methods and results The Nationwide Readmissions Database was utilized to identify hospitalizations with high-risk PE undergoing CDE or CDT from 2016 to 2019. The main outcome was all-cause in-hospital mortality. Propensity score matching was used to compare the outcomes in both groups. Among 3216 high-risk PE hospitalizations undergoing catheter-directed interventions, 868 (27%) received CDE, 1864 (58%) received CDT, and 484 (15%) received both procedures. In the unadjusted analysis, the rate of all-cause in-hospital mortality was not different between CDE and CDT (39.6% vs. 34.2%, P = 0.07). After propensity score matching, there was no difference in the incidence of in-hospital mortality [adjusted odds ratio (aOR): 1.28, 95% confidence interval (CI): 0.95, 1.72, P = 0.10], intracranial haemorrhage (ICH) (adjusted OR 1.57, 95% CI: 0.75, 3.29, P = 0.23), or non-ICH bleeding (aOR: 1.17, 95% CI: 0.85, 1.62, P = 0.33). There were no differences in the length of stay, cost, and 30-day unplanned readmissions between both groups. Conclusion In this contemporary observational analysis of patients admitted with high-risk PE undergoing CDT or CDE, the rates of in-hospital mortality, ICH, and non-ICH bleeding events were not different.

Citation

Sedhom, R., Elbadawi, A., Megaly, M., Athar, A., Bharadwaj, A. S., Prasad, V., …Elgendy, I. Y. (2023). Outcomes with catheter-directed thrombolysis vs. catheter-directed embolectomy among patients with high-risk pulmonary embolism: a nationwide analysis. European Heart Journal: Acute Cardiovascular Care, 12(4), 224-231. https://doi.org/10.1093/ehjacc/zuad004

• Journal Article Type: Article
• Acceptance Date: Feb 2, 2023
• Online Publication Date: Feb 4, 2023
• Publication Date: 2023-04
• Journal: European Heart Journal. Acute Cardiovascular Care
• Print ISSN: 2048-8726
• Publisher: SAGE Publications
• Volume: 12
• Issue: 4
• Pages: 224-231
• DOI: https://doi.org/10.1093/ehjacc/zuad004
• Keywords: Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine, General Medicine
• Publisher URL: https://academic.oup.com/ehjacc/article/12/4/224/7026146