Exploring race and mortality following pulmonary embolism intervention

Objective Race is a well-known risk factor for pulmonary embolism (PE); however, little is known about race-based outcomes following PE intervention(s). We sought to better understand the impact of race as it relates to the receipt of treatment modalities and mortality pre- and post-COVID 19. Methods We examined adult hospital admissions for PE who had subsequent PE interventions (catheter-directed thrombolysis, percutaneous mechanical thrombectomy, and open pulmonary artery thrombectomy) during the study period at a large academic healthcare network using our institution's administrative database. Given a low volume of patients who identified as Hispanic and/or race other than Black or White, we performed comparisons of White patients and Black patients. In the bivariate analysis, Chi-square tests were performed to compare categorical variables and Wilcoxon rank sum test for nonparametric data. Time-to-event outcomes were analyzed using Kaplan–Meier methods and compared with the log-rank test. Univariable and multivariable Cox proportional hazards regression models were used to evaluate associations with 1-year mortality. Firth penalized logistic regression was used to assess factors associated with 30-day mortality. Results Among 202 patients in the cohort, the median age was 60 [IQR:49-69] years, 52.0% (n=105) were Black. Black patients were younger at the time of hospital admission. Catheter-directed thrombolysis was utilized significantly more often (74%) in the pre-COVID era compared to the post-COVID era (15%). Percutaneous mechanical thrombectomy became the predominant treatment modality in the post-COVID era. 1-year mortality was 14%.. There was no significant race-based differences associated with 1 year mortality. Regression analysis revealed type 2 diabetes mellitus as the only risk factor of interest associated with 1 mortality. Conclusions Similar to other centers, our PE response team's (PERT) practice has evolved from primarily catheter-directed thrombolysis utilization towards a more heavy percutaneous mechanical thrombectomy practice. Unlike data from other institutions, we did not identify PE disparities in mortality after PE interventions. Examining system-level PERT care practices, such as through stakeholder engaged facilitator and barrier discussions, may yield critical insight into our health system's lack of race-based disparities in PE care.