Abstract Background Pulmonary embolism (PE) remains a leading cause of morbidity and mortality, contributing to approximately 33, 000 deaths annually in the United States. Pulmonary hypertension (PH) encompasses a diverse spectrum of disorders characterized by a mean pulmonary arterial pressure ≥20 mm Hg. Patients with pre-existing PH represent a particularly high-risk subgroup when presenting with acute PE; however, data comparing management strategies in this cohort are limited. This study compares the real-world outcomes of thrombectomy versus thrombolysis among PH patients hospitalized with acute PE in the United States. Methods A retrospective cohort study was conducted using the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (HCUP-NIS) database from 2018–2021. Adult patients with a principal diagnosis of PH and a concurrent diagnosis of acute PE were identified using ICD-10 codes. Weighted national estimates were calculated. Patients were stratified by treatment modality—mechanical thrombectomy versus systemic thrombolysis. Primary outcomes included in-hospital mortality, length of stay (LOS), and total hospitalization charges. Multivariable logistic and linear regression models adjusted for age, sex, race, income, Charlson comorbidity index, hospital region, teaching status, and bed size. Analyses were performed using STATA. Results From 27, 327, 220 hospitalizations during the study period, 881, 688 involved PH, of which 32, 936 patients had acute PE. The mean age was 60 years, and 51% were male. The use of thrombectomy increased significantly from 11. 0% in 2018 to 45. 8% in 2021 (p 0. 001). Thrombectomy was more commonly performed in large, tertiary teaching hospitals (85%, p = 0. 001), whereas thrombolysis was used more frequently in the Midwest (32. 6%) and South (40. 9%) regions (p = 0. 001). In adjusted models, thrombectomy performed in teaching hospitals was associated with markedly lower odds of in-hospital mortality (OR 0. 20, p = 0. 059), while thrombolysis was associated with higher mortality risk (OR 3. 6, p = 0. 045), likely reflecting bleeding-related complications. Compared with patients who did not receive intervention, total hospital charges increased by 161, 055 for thrombolysis (p = 0. 026) and 209, 944 for thrombectomy (p = 0. 002). Thrombectomy was also associated with a longer LOS (+6. 95 days, p = 0. 004). Conclusion In patients with chronic PH presenting with acute PE, thrombectomy use has substantially increased and is associated with improved survival compared with thrombolysis, albeit at higher cost and longer hospitalization. These findings underscore the evolving role of mechanical thrombectomy in high-risk PE populations and highlight the need for future cost-effectiveness and outcomes research to optimize resource utilization while maintaining survival benefits. This abstract is funded by: NA
Alagha et al. (Fri,) studied this question.