Early catheter-based therapy (<12 hours) was associated with a lower rate of the primary composite outcome compared to delayed therapy (4% vs 18%; HR 0.13; 95% CI 0.03-0.58; P=0.007).
Cohort (n=133)
Yes
Does early catheter-based therapy (<12 hours) reduce adverse clinical outcomes in patients with acute intermediate-risk pulmonary embolism compared to delayed therapy (≥12 hours)?
In patients with acute intermediate-risk pulmonary embolism, early catheter-based therapy (<12 hours) is associated with significantly improved clinical outcomes compared to delayed intervention.
Hazard Ratio: 0.13 (95% CI 0.03–0.58)
Absolute Event Rate: 4% vs 18%
p-value: p=0.007
BACKGROUND: The aim of this study was to examine the impact of early versus delayed catheter-based therapies (CBTs) on clinical outcomes in patients with acute intermediate-risk pulmonary embolism (PE). METHODS: This retrospective cohort study analyzed data from 2 academic centers involving patients with intermediate-risk PE from January 2020 to January 2024. Patients were divided into early (<12 hours) and delayed CBT (≥12 hours) groups. The primary outcome was a composite of 30-day mortality, resuscitated cardiac arrest, hemodynamic instability, and 90-day readmission. Secondary outcomes included a composite of 30-day mortality, resuscitated cardiac arrest, and hemodynamic instability. Inverse probability of treatment weighting was used to balance covariates. RESULTS: A total of 133 patients were included (mean age, 58.3 years; 44% women; 29% catheter-directed thrombolysis; 68% mechanical thrombectomy; and 3% both). The median time to intervention was 6.1 hours in the early group and 20.8 hours in the delayed group ( P <0.001). A total of 16 patients (12% of patients) experienced the primary composite outcome. Early CBT was associated with a significantly lower rate of the primary composite outcome (4% versus 18%; log-rank P <0.001; inverse probability of treatment weighting hazard ratio, 0.13 (95% CI, 0.03–0.58); P =0.007) and secondary composite outcome (0% versus 9%; log-rank P =0.02). The early CBT group also had lower intensive care unit (3.0 versus 3.4 days; P =0.01) and hospital length of stay (5.0 versus 6.1 days; P =0.046). When patients were stratified by timing of CBT (early/late) and the composite PE shock score (high ≥3; low <3), all 16 patients who experienced the primary composite outcome had a high composite PE shock score, with 14/16 (87.5%) having a high composite PE shock score and delayed intervention. CONCLUSIONS: Early CBT was associated with improved clinical outcomes in patients with acute intermediate-risk PE. The composite PE shock score may help identify patients who will benefit from early CBT. Further prospective studies are needed to validate these findings.
Zhang et al. (Wed,) conducted a cohort in acute intermediate-risk pulmonary embolism (n=133). Early catheter-based therapy (<12 hours) vs. Delayed catheter-based therapy (≥12 hours) was evaluated on composite of 30-day mortality, resuscitated cardiac arrest, hemodynamic instability, and 90-day readmission (HR 0.13, 95% CI 0.03-0.58, p=0.007). Early catheter-based therapy (<12 hours) was associated with a lower rate of the primary composite outcome compared to delayed therapy (4% vs 18%; HR 0.13; 95% CI 0.03-0.58; P=0.007).
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