J Vasc Surg Venous Lymphat Disord. 2021 May 6:S2213-333X(21)00101-3. doi: 10.1016/j.jvsv.2021.02.015. Online ahead of print.
OBJECTIVE: Catheter-based interventions (CBI) are an increasingly popular option for treating pulmonary embolism (PE), but the real benefits are unknown. The purpose of this study is to compare the outcomes of patients treated with CBI vs. those treated with medical or surgical approaches.
METHODS: This is a retrospective analysis of patients admitted between October 2015 to December 2017 with the diagnosis of acute PE. We compared patients ≥18 years old with the diagnosis of acute PE treated with CBI against a control group identified by propensity score matching. The control group was divided in those who received surgical pulmonary embolectomy (SPE) as the surgical group, and those who did not receive SPE as the medical group. The primary outcome was mortality (in-hospital and overall mortality). Secondary outcomes were major bleeding, length of hospital stay (LOS), thrombus resolution, right ventricle (RV) improvement in systolic function and dilatation and recurrent PE.
RESULTS: There were 30 patients in the CBI group and 78 patients in the control group (medical group=62, surgical group=16). Patient characteristics on admission were similar, except for body mass index which was higher in the CBI group (p=0.03). There was no difference in clinical severity, clot burden, RV function or biomarkers. Recurrent PE was less frequent in the CBI group compared with the medical group (0% vs. 6.4%). Otherwise, there was no significant difference in outcomes between CBI and the medical group. When CBI was compared with the surgical group, SPE was associated with improved mortality (0% vs. 16.6%) but had longer median LOS in days [IQR] (7 [3-12] vs. 8 [6.5-17]).
CONCLUSION: The use of CBI reduced recurrent PE events when compared with the medically treated patients; however, mortality was higher when compared with the surgical group.