Patients with pulmonary embolism and cardiogenic shock benefit from interventional therapy rather than conventional thrombolytic therapy. A case analysis of all inpatients in Germany 2022 and 2025

Background

Untreated pulmonary embolism (PE) with right heart failure (RHF) is associated with high mortality. The appropriate treatment for these patients is still a matter of debate.

Methods

The German InEK data collection system anonymously records all cases and DRG and OPS codes of patients who are hospitalized for PE and their treatment strategies, allowing mortality rates to be analyzed. We therefore analyzed all patients with PE and RHF (I26.0) who also exhibited symptoms of shock (R57.0, .8, .9).

Results

Of all 63361 patient cases between January 2022 and September 2025, a total of 13,78% died. Patients who went into shock (4104) died at a rate of 57,56%. Of these patient cases, 1829 received systemic lysis (SL, 8-020.8), with an average mortality rate of 55,48 %. 463 patients underwent invasive thrombus aspiration (TA, 8-838.n0), with an average mortality rate of 44,08 %, and a few patients (129) underwent ultrasound-guided regional lysis (URL, 8-83b.j), with a mortality rate of 36,66 %.

It should be noted that TA, which was still associated with a 63,89% mortality rate in 2022, has fallen steadily to 35,22 % by 2025.

Conclusion

Patients with PE combined with shock have a high mortality rate. Classic SL therapy can hardly improve this mortality rate. In contrast, interventional procedures for TA or URL lead to a nearly halving of the mortality rate.Impatient Mortality in PE and shockFor image description, please refer to the figure legend and surrounding text.