Abstract No. 505 Unplanned 6-Month Readmissions and In-Hospital Outcomes for the Management of Acute Intermediate-Risk Pulmonary Embolism: Comparisons of Endovascular Interventions

To compare catheter-directed thrombolysis (CDT) and endovascular mechanical thrombectomy (MT) for acute intermediate-risk pulmonary embolism (PE) with respect to unplanned 6-month readmissions and in-hospital outcomes using a national database. The NRD was queried from 2016 to 2019 for adult patients with acute nonseptic PE. High-risk PE was distinguished from intermediate-risk PE if patients had concurrent International Classification of Diseases (ICD-10) codes corresponding to mechanical ventilation, vasopressor usage, or shock; those admissions were excluded. Inverse probability weighted regression adjustment was used, in which both the treatment and outcome models were adjusted for age, gender, insurance status, IVC filter placement and Elixhauser Comorbidity Index surrogating for disease severity. This was used to compare CDT and MT with regards to in-hospital mortality, unplanned 6-month readmissions, discharge other than home (DOTH), gastrointestinal bleeding (GIB), intracranial hemorrhage (ICH), blood transfusion, and total charge. Results are depicted as average treatment effect (ATE). A total of 9,577 patients were identified; 8,716 (91%) underwent CDT and 861 (9.0%) underwent MT. Compared to CDT, the ATE of MT was similar with regards to in-hospital mortality (ATE: 0.011; p=0.08), GIB at index admission (ATE: 0.012; p=0.12), blood transfusion (ATE: -0.004; p=0.52), total charge (ATE: 0.040; p=0.11), 6-month GIB (ATE: -0.002; p=0.62), 6-month ICH (ATE: 0.009; p=0.084), 6-month blood transfusion (ATE: 0.008; p=0.21) and 6-month mortality (ATE: 0.011; p=0.13). The ATE of MT was higher than that of CDT for DOTH (ATE: 0.044; p=0.025), ICH at index admission (ATE: 0.017; p=0.003), unplanned readmission (ATE: 0.043; p=0.027) and repeat PE at 6 months (ATE: 0.025; p=0.049). MT was associated with higher rates of DOTH, index ICH, unplanned readmission, and repeat PE compared to CDT in acute submassive PE. MT was associated with similar rates of 6-month GIB, ICH, and mortality compared to CDT.