Mortality in patients undergoing catheter-based therapy vs. anticoagulation alone for intermediate-high risk pulmonary embolism

TL;DR

The study compared catheter-based therapy and anticoagulation alone for treating intermediate-high risk pulmonary embolism and found no significant difference in mortality.

Contribution

This study provides new insights into treatment outcomes for intermediate-high risk pulmonary embolism patients using a retrospective analysis.

Findings

Overall mortality was 12.0% at 12 months for all intermediate-high risk pulmonary embolism patients.

Mortality rates were 14.0% in the conservative group and 11.0% in the interventional group, with no significant difference.

Catheter-based treatment did not significantly reduce mortality compared to anticoagulation alone within 12 months.

Abstract

Pulmonary embolism is a common and potentially fatal medical condition. Current guidelines recommend therapeutic anticoagulation for intermediate-high risk pulmonary embolism as a first-line strategy. However, it is unclear whether these patients may benefit from interventional treatments, such as catheter-based thrombectomy or catheter-based thrombolysis, compared to anticoagulation alone regarding mortality. Our aim was to gain insight into optimal treatment strategies of intermediate-high risk PE patients and to evaluate outcomes of different management strategies with regard to all-cause mortality.

We retrospectively evaluated a total of 236 patients, 133 patients undergoing catheter-based thrombectomy or catheter-based thrombolysis (interventional group) and 103 patients receiving anticoagulation alone (conservative group) at our institution between 2003 and 2024. All patients were classified as intermediate-high risk. The primary endpoint was all-cause mortality.

The overall mortality for all patients with intermediate-high risk pulmonary embolism was 12.0% at 12 months. Depending on the treatment approach, all-cause mortality after 12 months occurred in 14 of 103 patients (14.0%) in the conservative group and in 14 of 133 patients (11.0%) in the interventional group which did not significantly differ (p = 0.150).

In patients with acute intermediate-high risk pulmonary embolism catheter-based treatment did not show a significant reduction in mortality within 12 months compared to anticoagulation alone.

Graphical overview of background, patient selection, study flow and outcome of the study.Central illustration graphic summarizing a study on mortality for intermediate-high risk pulmonary embolism patients, comparing anticoagulation alone with anticoagulation plus catheter-based therapy. Flow diagram shows 103 receiving anticoagulation alone and 133 catheter-based therapy. Kaplan-Meier curve demonstrates no statistically significant difference in survival over twelve months between groups.

Graphical overview of background, patient selection, study flow and outcome of the study.

Figures