Key result
Catheter-directed intervention shows no 90-day survival benefit over anticoagulation alone in high-risk PE.
Why the study?
Does catheter-directed intervention improve 90-day survival or right heart recovery in patients with high-risk pulmonary embolism compared to anticoagulation alone?
Cohort (n=45)
No
Does catheter-directed intervention improve 90-day survival or right heart recovery in patients with high-risk pulmonary embolism compared to anticoagulation alone?
Catheter-directed interventions in high-risk pulmonary embolism patients appear safe and accelerate right ventricular recovery, though they did not yield a 90-day survival benefit compared to historical anticoagulation alone.
No survival benefit observed with catheter-directed intervention; observational data leave open accelerated right ventricular recovery in high-risk pulmonary embolism.
BACKGROUND: First-line treatment of high-risk pulmonary embolism with persistent hypotension and/or signs of shock is intravenous thrombolysis. However, if thrombolysis is contraindicated due to risk of serious bleeding, or if it yields insufficient effect, surgical thrombectomy or catheter-directed intervention (CDI) plus anticoagulation is recommended. The aim of this study was to assess the outcomes of the CDI modality introduced in a tertiary referral centre in 2013. METHODS: Retrospective comparison between patients treated with CDI plus anticoagulation (n = 22) and patients treated with anticoagulation only (n = 23) as used before the CDI technique was available. The main outcomes of interest were 90-day survival and reduction of right to left ventricle diameter (RV/LV) ratio, using the Fischer's exact test and a mixed model, respectively, for statistical analysis. RESULTS: Ninety-day survival was 59% after CDI and 61% after anticoagulation only; P = .903. The rate of RV/LV ratio reduction was 0.4 units higher per 24 hours in the CDI group (median 2.1 pre-treatment), than in the anticoagulation only group (median 1.3 pre-treatment); P = .007. CONCLUSION: In patients with high-risk pulmonary embolism, 90-day survival was similar after treatment with CDI plus anticoagulation compared to anticoagulation only. The mean reduction in RV/LV ratio was larger in the CDI group. Our results support the use of CDI in selected patients, respecting the limitations and potential side effects of each technical device used.
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Einarsson et al. (2020) conducted a cohort in High-risk pulmonary embolism (n=45). Catheter-directed intervention (CDI) plus anticoagulation vs. Anticoagulation only was evaluated on 90-day survival (p=0.903). In patients with high-risk pulmonary embolism, 90-day survival was similar after treatment with catheter-directed intervention plus anticoagulation compared to anticoagulation alone (59% vs 61%, P=0.903).
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