Abstract 4126672: Clinical Predictors and Outcomes of Catheter-Directed Therapies in Patients with Intermediate-Risk Central Pulmonary Embolism

Background: The management of intermediate-risk pulmonary embolism (PE) is unclear. The use of catheter-directed therapies (CDTs) in these patients has increased. However, their selection is not standardized, and outcomes of CDT compared to anticoagulation alone (ACA) are limited.

Research Question: What are the clinical predictors of using CDT and their outcomes compared to ACA?

Methods: Single center, 11-year, retrospective study of patients with intermediate-risk central PE. We stratified data by CDT use vs. ACA. We used the simplified pulmonary embolism severity index (sPESI) and right ventricular (RV) dysfunction as surrogates of PE severity and the VTE-BLEED score for baseline bleeding risk. We looked for predictors of CDT use and bleeding complications on multivariate logistic regression analyses.

Results: Of 490 patients identified, 110 (22%) underwent CDT (Figure 1, Table 1). Higher BMI (OR 1.04, 95% CI 1.01-1.06; p=0.002), prior venous thromboembolism (VTE) episodes (OR=1.92, 95% CI 1.05-3.50; p=0.032), saddle PE (OR=3.42, 95% CI 2.00-5.85; p<0.0001), RV dysfunction (OR=6.93, 95% CI 3.53-13.57; p<0.0001), and creatinine elevation (OR=1.36, 95% CI 1.13-1.64; p=0.001) were independently associated with CTD use (Table 2). After adjusting for PE severity and bleeding risk, CDT was independently associated with bleeding complications (OR=3.77, 95% CI 1.74-8.15; p=0.001) (Table 3). The overall in-hospital mortality was low (3%, n=13).

Conclusions: Higher BMI, prior VTE, saddle PE, RV dysfunction, and creatinine elevation were independently associated with CDT use. The CDT group had more major bleeding without mortality difference compared to ACA. Further studies are needed to standardize the use of CDT in intermediate-risk PE.