Females with pulmonary embolism were significantly less likely to receive percutaneous thrombectomy (adjusted OR 0.848) compared to males, despite having lower rates of acute complications.
Does percutaneous thrombectomy reduce mortality in patients with acute pulmonary embolism and cor pulmonale, and are there sex disparities in its utilization?
In a large U.S. cohort of patients with acute pulmonary embolism and cor pulmonale, percutaneous thrombectomy reduced mortality, but women were significantly less likely to receive the intervention despite having lower complication rates.
Absolute Event Rate: 0% vs 0%
Abstract Background Pulmonary embolism (PE) is a life-threatening condition increasingly treated with percutaneous thrombectomy in patients with thrombolysis contraindications or hemodynamic compromise. Recent studies have identified significant sex-based disparities in both access to and outcomes following thrombectomy for PE.(1) Methods We conducted a retrospective cohort analysis using the National Inpatient Sample (NIS), a large, publicly available database of U.S. hospital discharges using data from 2016-2022. Patients with acute PE were identified and subgrouped by cor pulmonale presence and thrombectomy receipt. Logistic regression yielded crude and adjusted odds ratios (ORs) for mortality controlling for age, comorbidities and hospital factors. Trends were analyzed via proportions and time-effect regression. Sex-stratified analyses compared mortality, LOS, charges, comorbidities, and complications. Means and proportions were reported with p-values 0.05 significant. Results Among with pulmonary embolism and cor pulmonale, 10.2% received thrombectomy with increasing rates over time from 2.8% in 2016 to 21.1% in 2022 (p0.001). Females were less likely to receive thrombectomy (adjusted OR: 0.848, 95% CI: 0.788–0.912, p 0.001). Mortality was lower in the thrombectomy group (6.1% vs. 8.7%, p 0.001), with no significant sex difference in mortality risk (OR for female: 0.993, 95% CI: 0.917–1.075, p = 0.864). The crude OR for mortality with thrombectomy was 0.69 (95% CI: 0.59–0.79, p0.001), and the adjusted OR was 0.73 (95% CI: 0.62–0.84, p0.001), indicating a significant mortality reduction. Females were slightly older (mean age 64.5 years vs. 61.8 years for males, p 0.001) but had a lower prevalence of hypertension, diabetes, and coronary artery disease (p 0.05 for all). Females had lower rates of thrombectomy related complications overall as shown in Table 2. Conclusion Women had lower rates of thrombectomy, potentially due to scoring systems such as Pulmonary Embolism Severity Index (PESI) that include male sex as a risk factor for increased mortality. In our study, women demonstrated consistently lower rates of acute complications from thrombectomy and overall lower mortality rates from PE. A prior study showed higher incidence of complication in women, but our study looking at a large national sample shows lower overall risk of severe complications from thrombectomy possibly due increasing use of thrombectomy.2 Our study is consistent with recent large database studies showing higher mortality among PE in male patients.3 These results highlight the need for equitable access to thrombectomy and further investigation into sex-specific risk stratification to optimize outcomes.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.
Cohen et al. (Sun,) reported a other. Females with pulmonary embolism were significantly less likely to receive percutaneous thrombectomy (adjusted OR 0.848) compared to males, despite having lower rates of acute complications.
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