(1053) Comparative Analysis of Reperfusion Approaches in Pulmonary Embolism: A Nationwide Analysis

Introduction: Reperfusion therapy is crucial for the management of high-risk pulmonary embolism; alternative approaches include systemic thrombolysis, catheter-based and mechanical embolectomy. This study aimed to compare the outcomes and patient characteristics of each type of reperfusion approach.

Methods: We utilized the Nationwide Readmissions Database from 2017 to 2020 to identify patients diagnosed with pulmonary embolism (PE) who received either mechanical thrombolysis, catheter-directed thrombolysis (CDT), or systemic thrombolysis. The study population was categorized according to the type of therapy received. The groups were compared based on patient characteristics, length of stay (LOS), complications, total charges, and mortality.

Results: A total of 1,180,298 cases of PE were identified. Of those, 68,266 patients (5.78%) underwent one of three types of treatment, 9.3% (6,337) received mechanical thrombectomy, 47.9% (32,704) underwent CDT, and 50.1% (34,135) received systemic thrombolysis. CDT was associated with higher median age (62 [49-72] years) compared to mechanical thrombectomy and systemic thrombolysis (p < 0.001). Gender differences were also significant (p < 0.001), with a higher proportion of females (53.1%) undergoing mechanical thrombectomy compared to CDT (47.3%) and systemic thrombolysis (49.2%). Additionally, patients treated with mechanical thrombolysis had longer hospital stays (7 [4-14] days) compared to the two other groups (p < 0.001). Differences were also observed in discharge disposition and the year of treatment among the three modalities (p < 0.001). However, there were no significant differences in total charges (p = 0.209). Regarding treatment outcomes, notable differences were observed in complications among the treatment modalities. Mechanical thrombectomy had a higher incidence of stroke (2%) and bleeding requiring transfusions (12%), while the CDT group had the lowest rate of complications (p < 0.001). Mortality was higher in the systemic thrombolysis group and lowest in the CDT group, with a mortality rate of 4.7% (p < 0.001).

Conclusions: CDT seems to be a superior treatment approach for high-risk pulmonary embolism, exhibiting lower complication rates, shorter hospital stays, and reduced mortality compared to systemic thrombolysis and mechanical thrombectomy.