Outcomes in patients with intermediate-high risk pulmonary embolism submitted to catheter-directed therapy presenting with normotensive-shock

Abstract Introduction - Acute pulmonary embolism (PE) is a heterogenous disease that ranges from asymptomatic peripheral embolism to massive embolism that may present with hemodynamic collapse. Risk stratification of patients (pts) is recommended for therapeutic management approach. However, with the catheter directed therapy (CDT) advent, re-stratification is being discussed. In pts with intermediate-high risk PE, although not presenting with hypotension, a subset of pts may present with impaired cardiac function, categorized as normotensive shock (NTS). This study aims to assess outcomes in NTS pts submitted to CDT. Methods – A prospective registry of consecutive PE pts submitted to (CDT) in a single tertiary centre was used. This analysis included only intermediate-high risk pts, who were divided into two groups based on the presence of NTS, defined as a cardiac index ≤ 2.2 L/min/m², at right heart catheterization. Clinical, biochemical, echocardiographic, radiologic and right heart catheterization data were collected at admission and at 3-6 month follow-up. Two composite endpoints were analysed across the two groups. The first was a composite endpoint of short-term outcomes that included 30-day mortality, intensive care unit length of stay, post-intervention complications and right ventricular disfunction (assessed by transthoracic echocardiography) at discharge. The second composite endpoint evaluated long-term outcomes and was composed by the presence of pulmonary hypertension by RHC, right ventricular disfunction on echocardiogram, performance on CPET or 6MWT (using the threshold of 85% predicted), hospitalizations and mortality and included only the pts that were re-evaluated at the 3-6 month follow-up. Results – 85 pts (50,6% female, mean age 59 ± 17 years) were admitted for intermediate-high risk PE. 25 pts (29,4%) had normotensive shock at admission. Statistically significant differences between the two groups were heart rate (99 vs 103; p=0,035); lactate levels (1,4 vs 1,8; p=0,026); haemoglobin levels (13,2 vs 14,3; p= 0,012) and SvO2 (66,7 vs 55,3; p0,001). There were no statistically significant differences between the two groups regarding the composite endpoint of short-term outcomes (p=0,693). 52 pts of the baseline group had a follow-up at 3-6 months, with 15 (28,8%) of these pts having NTS at admission. There were also no statistically significant differences between the two groups regarding the composite endpoint of long-term outcomes (p=0,973). Conclusion – In our cohort of intermediate-high risk PE pts submitted to CDT, no statistically significant differences were observed regarding short- and long-term outcomes in pts presenting with or without NTS. While this could mean that CDT are effective at improving prognosis despite the presence of NTS, a longer follow-up may be needed to more comprehensively evaluate long-term outcomes.Baseline characteristics