Survival and recurrence after acute pulmonary embolism treated with pulmonary embolectomy or thrombolysis in New York State, 1999 to 2013.

Abstract

Pulmonary embolism (PE) results in more than 250,000 hospitalizations annually in the United States, with high mortality. Outcome data are limited, and reperfusion strategies remain controversial. Here we evaluated the outcomes of thrombolysis and surgical embolectomy in patients with acute PE using a statewide database. Among 174,322 patients hospitalized with PE in New York State between 1999 and 2013, we performed a retrospective comparison of 2111 adults with acute PE who underwent either thrombolysis (n = 1854; 88%) or surgical embolectomy (n = 257; 12%) as first-line therapy. Patients were identified using a mandatory database. The median follow-up was 4.2 years (range, 0-16.3 years). The primary study endpoint was all-cause mortality; secondary outcomes included recurrent PE, recurrent deep vein thrombosis, reintervention, and stroke. In 2111 patients who underwent reperfusion, there was no difference in 30-day mortality between those who underwent thrombolysis and those who underwent surgical embolectomy (15.2% vs 13.2%; odds ratio [OR], 1.12, 95% confidence interval [CI], 0.72-1.73). Thrombolysis was associated with higher risk of stroke (1.9% vs 0.8%; OR, 4.70; 95% CI, 1.08-20.42) and reintervention (3.8% vs 1.2%; OR, 7.16; 95% CI, 2.17-23.62) at 30 days. Five-year actuarial survival was similar in the 2 groups (72.4% [95% CI, 70.3%-74.5%] vs 76.1% [95% CI, 70.2%-81.0%]; hazard ratio (HR) for death, 1.11; 95% CI, 0.83-1.49). Thrombolysis was associated with a higher rate of recurrent PE necessitating inpatient readmission (7.9% [95% CI, 6.9%-9.4%] vs 2.8% [95% CI, 1.1%-5.8%]; HR, 3.38; 95% CI, 1.48-7.73). Pulmonary embolectomy and thrombolysis are associated with similar early and long-term survival, supporting guideline recommendations for embolectomy when thrombolysis is contraindicated.