Effects of Early Versus Delayed Mechanical Thrombectomy on Outcomes in Intermediate-Risk Acute Pulmonary Embolism.

Abstract

Evidence guiding the optimal timing of mechanical thrombectomy for patients presenting with intermediate-risk pulmonary embolism (PE) is limited. We aimed to evaluate whether the timing of mechanical thrombectomy is associated with improved clinical outcomes in this patient population. This multicenter, retrospective cohort study was conducted at five large academic hospitals. In total, 290 patients presenting with intermediate-risk PE who were treated with mechanical thrombectomy were included for analysis. The primary outcome was in-hospital mortality. Using generalized estimated equation, we compared the odds of in-hospital mortality for patients undergoing early intervention (EI; mechanical thrombectomy < 12 hr after PE diagnosis) vs. those undergoing delayed intervention (DI; mechanical thrombectomy ≥ 12 hr after diagnosis) while comparing for PE severity and other confounders. None. EI was performed in 179 patients (61.7%), while 111 patients (38.3%) received DI. Unadjusted mortality did not differ significantly between groups (7.3% [13/179] vs. 10.8% [12/111]; p = 0.39). After adjusting for the Pulmonary Embolism Severity Index and Composite Pulmonary Embolism Shock scores, timing of intervention did not influence mortality (odds ratio, 1.80; 95% CI, 0.82-3.95; p = 0.14). However, patients in the EI group had greater reductions in in pulmonary artery systolic pressure (-25.8% [17.0] vs. -18.9% [17.1]; p = 0.020 and mean pulmonary artery pressure, -26.8% [17.7] vs. -20.2% [19.7]; p = 0.016) and lower rates of intubation (8.9% [16/179] vs. 18% [20/111]; p = 0.028). In patients presenting with intermediate-risk PE, timing of mechanical thrombectomy did not influence in-hospital mortality. EI may result in greater reductions in pulmonary artery pressures and decreased incidence of intubation compared with DI.