Abstract 14686: Prevalence and Predictors of Normotensive Shock in Intermediate-Risk Pulmonary Embolism

Abstract

Introduction: In patients presenting with pulmonary embolism (PE) and shock/hypotension (high-risk PE), immediate thrombolytic therapy or mechanical thrombectomy is recommended. However, the prevalence and predictors of normotensive shock in patients with intermediate-risk PE are not well defined. Methods: PE patients undergoing mechanical thrombectomy with the FlowTriever System (Inari Medical) were enrolled in the FLASH Registry. Patients were included in this analysis if they were intermediate-risk per ESC guidelines (i.e., normotensive) and had cardiac index (CI) measured pre- and post-thrombectomy. Invasive hemodynamics were measured pre- and post-thrombectomy and compared using paired data. Patients were grouped into those with normotensive shock (CI ≤ 2.2 l/min/m 2 ) or without shock (CI > 2.2 l/min/m 2 ). Multiple logistic regression was used to identify baseline predictors of normotensive shock. Safety outcomes through 30 days were recorded. Results: Out of 384 intermediate-risk PE patients, more than one-third (131, 34.1%) were in normotensive shock at baseline. The shock group had significantly lower BMI, higher RV/LV ratio, and higher rates of moderately/severely reduced RV function and concomitant DVT (Table). Significant predictors of shock included tachycardia, distal concomitant DVT, moderately/severely reduced RV function, and saddle PE. The normotensive shock group showed significant on-table improvement in CI and mean PA pressure post-thrombectomy (Figure). Safety profiles were not significantly different between groups, with similarly low rates of major adverse events and mortality through 30 days (Table). Conclusion Although identified as intermediate-risk, over one-third of patients had normotensive shock, suggesting they may be at risk of hemodynamic deterioration despite appearing stable. Treatment with mechanical thrombectomy improved patient hemodynamics on the table, with low rates of mortality in both groups.