The study aimed to determine if use of mechanical thrombectomy (MT) impacts survival and additional outcomes in patients with acute intermediate-high and high-risk pulmonary embolism (PE) patients who were evaluated by a PE response team (PERT). This retrospective, single-center study included intermediate-high and high-risk PE patients who received PERT evaluation over 3.5 years, treated with anticoagulation (AC) alone or MT and anticoagulation (MT+AC). The primary outcome was 30-day all-cause mortality, measured with inverse probability of treatment weighting. Exploratory outcomes included survival during the study period, PE-associated/caused mortality, length of hospital stay (LOS), supplemental oxygen at discharge, and MT-related metrics. Of 335 patients, 259 received AC alone while 76 received MT+AC. The use of MT was associated with reduced odds of 30-day all-cause mortality (OR=0.49, 95%CI=0.27-0.76, p=0.002). There were no significant differences in PE-associated/caused mortality. Hospital LOS was 2 days shorter in the MT+AC cohort (p<0.001). Of patients receiving MT+AC, high-risk PE had a 4.5 days shorter stay (p<0.001), while intermediate-high risk had 2 days shorter stay (p<0.001). The proportion of patients receiving supplemental oxygen at discharge was lower in MT+AC patients (MT+AC=4.1% vs AC=18.5%, p<0.001), without significant differences in 30-day readmission rates (MT+AC=9.5% vs AC=20.6%, p=0.115). MT resulted in an 8.7 mmHg reduction in mean pulmonary artery pressure, had a technical success rate of 100% (76 of 76), and an adverse event rate of 6.6% (5 of 76). MT reduced 30-day all-cause mortality, hospital LOS, and supplemental oxygen at discharge in the intermediate-high and high-risk PE population.
Nolan et al. (Mon,) studied this question.