F-33 | Nationwide Outcomes in Intermediate to High-Risk Pulmonary Embolism Treated with Catheter-based Therapies

The mortality rate of pulmonary embolism is as high as 30% and affects 900,000 individuals in the United States per year. Catheter-based therapies (CBT), including catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT), have been developed to treat patients with intermediate- and high-risk pulmonary embolisms. This study aims to characterize the outcomes in patients admitted with intermediate or high-risk pulmonary embolism treated with MT compared with CDT. The 2020 National Inpatient Sample data was used to analyze outcomes in hospitalized pulmonary embolism patients who received CDT and MT. The primary and secondary outcomes were in-hospital mortality, length of hospital stay, and significant bleeds, including gastrointestinal or brain bleeds. 82,179 cases of pulmonary embolism were identified. 2,951 cases (3.6%) received catheter-based therapies (CBT), of which 1,513 (51.27%) received CDT, 1308 (44.32%) received MT, and 130 (4.41%) received a combination of CDT and MT. There were no differences in the incidence of major complications between the MT and CDT groups, including gastrointestinal bleeding (p=0.14) and intracranial bleeding (p=0.26). The length of stay (6.65 vs. 5.46 days, p<0.001) was higher in the MT group than in the CDT. In the multivariate analysis, MT was associated with increased all-cause inpatient mortality (OR 2.41, 95% CI 1.72-3.39, p<0.001). In addition, patients were more likely to get MT than CDT if they had saddle pulmonary embolism (OR 1.28, 95% CI 1.10-1.50, p=0.002), were admitted to medium-sized (OR 1.45, 95% CI 1.14-1.84, p=0.002) or large-sized hospitals (OR 1.73, 95% CI 1.39-2.15, p<0.001), were admitted to urban teaching hospitals (OR 1.93, 95% CI 1.26-2.93, p=0.002), or were older (OR 1.009, 95% CI 1.004-1.014, p<0.001). Our study shows that CBT use is still limited in PE patients, and the use of MT is lower than CDT. Patients who received MT had increased all-cause inpatient mortality compared to those who received CDT.