SS19 - Improved Short and Long-term Survival with Catheter Directed Therapies over Medical Management in Patients with Submassive Pulmonary Embolism - A Retrospective Matched Cohort Study

Objectives: The benefit of catheter directed therapies (CDT) for submassive pulmonary embolism (sPE) is subject of debate. We sought to determine short and long-term mortality and outcomes of CDT compared to anticoagulation (AC) in patients with sPE.

Methods: This is a single healthcare network, multi-hospital, retrospective cohort study of all hospitalizations for sPE (2012-2019). sPE was defined as presence of at least one of the following: right heart strain (RHS), elevated biomarkers (Troponin-I or B-type natriuretic peptide), or vital sign abnormalities (heart rate [HR]≥110 bpm). Patients with massive PE (SBP < 90 mmHg or vasopressor support) and those who received systemic thrombolysis were excluded. sPE groups included therapeutic AC alone or AC with CDT (thrombolysis and suction thrombectomy). Measured outcomes included mortality, treatment related complications (bleeding, transfusion, stroke) chronic thromboembolic pulmonary hypertension (CTEPH) and 6-minute walk test (6MWT). After 1:1 nearest-neighbor propensity score matching, Kaplan Meier survival plots were generated for the treatment groups and compared using log-rank testing (Fig. 1). Multivariate Cox regression was used to determine effect of treatment on 1-year, 3-year, and 5-year survival after adjusting for confounding variables and clustering on hospitals.

Results: Of 6,746 sPE hospitalizations, 235 patients receiving CDT were matched with 235 patients who received AC. Patients receiving CDT were younger (58.9±15.5 vs 61.5±17.4 years, p=0.004) and more likely to be White (92.5% vs 85.7%; p< 0.001). Those who received CDT presented with higher HR, lower SBP, and were more likely to have RHS (Table I). In the matched cohort, no difference was seen in the development of CTEPH (4.3% vs. 4.3%; p-value=1.0) at a mean follow up of 2-years. The 6MWT at 1-year was similar between the 2 groups (332.7 meters vs. 318.8 meters; p-value=0.62). However, AC alone was associated with higher PE-related death within 30 days (1.7% vs. 0.4%; p-value=0.047). CDT was also associated with lower rate of complications at 30-days (1.49% vs. 4.25%; p-value=0.176) and at 3-years (1.49% vs. 16.6%; p-value=0.009). CDT was associated with a lower risk of mortality compared to AC at 1-year (7.6% vs 9.8%; HR 0.77; 95% CI 0.65-0.92; p-value=0.004), 3-years (11.1% vs. 16.6%; HR 0.64; 95% CI 0.55-0.73; p-value < 0.001), and 5-years (14.5% vs. 19.1%; HR 0.71; 95% CI 0.66-0.77; p-value < 0.001).

Conclusions: CDT for sPE is associated with improved short and long-term survival compared to AC alone, with a low complication rate. CDT should be considered in select patients with sPE given its survival benefit.