Abstract
(1) Background: Catheter-directed therapies (CDT) may be considered for selected patients with pulmonary embolism (PE); (2) Methods: Retrospective observational study including all consecutive patients with acute PE undergoing CDT (mechanical or pharmacomechanical) from January 2010 through December 2020. The aim was to evaluate in-hospital and long-term mortality and its predictive factors; (3) Results: We included 63 patients, 43 (68.3%) with high-risk PE. All patients underwent mechanical CDT and, additionally, 27 (43%) underwent catheter-directed thrombolysis. Twelve (19%) patients received failed systemic thrombolysis (ST) prior to CDT, and an inferior vena cava (IVC) filter was inserted in 28 (44.5%) patients. In-hospital PE-related and all-cause mortality rates were 31.7%; 95% CI 20.6–44.7% and 42.9%; 95% CI 30.5–56%, respectively. In multivariate analysis, age > 70 years and previous ST were strongly associated with PE-related and all-cause mortality, while IVC filter insertion during the CDT was associated with lower mortality rates. After a median follow-up of 40 (12–60) months, 11 more patients died (mortality rate of 60.3%; 95% CI 47.2–72.4%). Long-term survival was significantly higher in patients who received an IVC filter; (4) Conclusions: Age > 70 years and failure of previous ST were associated with mortality in acute PE patients treated with CDT. In-hospital and long-term mortality were lower in patients who received IVC filter insertion.
Highlights
Pulmonary embolism (PE) is among the most common causes of vascular mortality after myocardial infarction and stroke, being the leading preventable cause of death in hospitalized patients [1]
Residual deep venous thrombosis (DVT) was observed in 72.3% of patients
pulmonary embolism (PE)-related mortality rate was 31.7%; 95% confidence intervals (CIs) 20.6–44.7%, being significantly higher among high-risk patients (p = 0.051) (Table 2)
Summary
Pulmonary embolism (PE) is among the most common causes of vascular mortality after myocardial infarction and stroke, being the leading preventable cause of death in hospitalized patients [1]. Shock and systemic hypotension identify those PE patients at high risk of mortality [2]. Guidelines recommended the use of ST for (1) patients with acute symptomatic PE and hemodynamic instability who do not have major contraindications owing to bleeding risk, and (2) patients without hypotension who experience hemodynamic deterioration while receiving anticoagulant therapy [4]. Despite these recommendations, ST is an underused treatment, with some studies indicating that only 30% of high-risk PE patients receive it [9,10]. Concern about MB and intracranial hemorrhage could be among the main factors responsible for this underuse [11]
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