Key result
Catheter-directed therapies are linked to lower mortality than systemic lysis in PE with shock.
Why the study?
Untreated pulmonary embolism with right heart failure carries high mortality, and the appropriate treatment strategy for these patients remains a matter of debate.
Does interventional therapy (invasive thrombus aspiration or ultrasound-guided regional lysis) reduce inpatient mortality compared to conventional systemic lysis in hospitalized patients with pulmonary embolism, right heart failure, and shock?
Observational (n=4,104)
Yes
Does interventional therapy (invasive thrombus aspiration or ultrasound-guided regional lysis) reduce inpatient mortality compared to conventional systemic lysis in hospitalized patients with pulmonary embolism, right heart failure, and shock?
In a German nationwide analysis of patients hospitalized with pulmonary embolism, right heart failure, and shock, catheter-based interventional therapies (thrombus aspiration and ultrasound-guided regional lysis) were associated with substantially lower inpatient mortality rates compared to conventional systemic thrombolysis.
Answers are grounded in this paper and cite their sources.
Catheter-directed therapies were associated with lower mortality in PE shock; leaves open whether they improve outcomes over systemic lysis in RCTs.
Background Untreated pulmonary embolism (PE) with right heart failure (RHF) is associated with high mortality. The appropriate treatment for these patients is still a matter of debate. Methods The German InEK data collection system anonymously records all cases and DRG and OPS codes of patients who are hospitalized for PE and their treatment strategies, allowing mortality rates to be analyzed. We therefore analyzed all patients with PE and RHF (I26.0) who also exhibited symptoms of shock (R57.0, .8, .9). Results Of all 63361 patient cases between January 2022 and September 2025, a total of 13,78% died. Patients who went into shock (4104) died at a rate of 57,56%. Of these patient cases, 1829 received systemic lysis (SL, 8-020.8), with an average mortality rate of 55,48 %. 463 patients underwent invasive thrombus aspiration (TA, 8-838.n0), with an average mortality rate of 44,08 %, and a few patients (129) underwent ultrasound-guided regional lysis (URL, 8-83b.j), with a mortality rate of 36,66 %. It should be noted that TA, which was still associated with a 63,89% mortality rate in 2022, has fallen steadily to 35,22 % by 2025. Conclusion Patients with PE combined with shock have a high mortality rate. Classic SL therapy can hardly improve this mortality rate. In contrast, interventional procedures for TA or URL lead to a nearly halving of the mortality rate.
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Lange et al. (2026) conducted an observational in Pulmonary embolism with right heart failure and cardiogenic shock (n=4,104). Invasive thrombus aspiration or ultrasound-guided regional lysis vs. Systemic lysis was evaluated on In-hospital mortality. Invasive thrombus aspiration (44.08% mortality) and ultrasound-guided regional lysis (36.66%) showed lower mortality than systemic lysis (55.48%) in PE with shock.
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