Unplanned 6-month readmissions and in-hospital outcomes for the management of acute intermediate- and high-risk pulmonary embolism: comparisons of endovascular interventions.

BACKGROUND: To compare catheter directed thrombolysis (CDT) and endovascular mechanical thrombectomy (MT) for acute intermediate-risk and high-risk pulmonary embolism (PE) with respect to unplanned 6-month readmissions and in-hospital outcomes using a national database. METHODS: The NRD was queried from 2016 to 2022 for adult patients with acute nonseptic PE who received either CDT or MT. Inverse probability weighted regression adjustment was used to compare CDT and MT with regard to in-hospital mortality, unplanned 6-month readmissions, discharge other than home (DOTH), total cost as well as gastrointestinal bleeding (GIB), intracranial hemorrhage (ICH), blood transfusion at index admission, and 6-month readmission. Results are depicted as average treatment effect (ATE). RESULTS: A total of 28,376 patients were identified; 18,168 (64%) underwent CDT and 10,208 (36%) underwent MT. There was a total of 3,945 patients with high risk PE (13.9%). Compared to CDT, the ATE of MT was higher with regards to in-hospital mortality (ATE: 0.007; p = 0.048), DOTH (ATE: 0.031; p < 0.001), ICH (ATE: 0.006; p < 0.001), total cost at index admission (ATE: 0.118; p < 0.001), GIB at 6 months (ATE: 0.004; p = 0.023), blood transfusions at 6 months (ATE: 0.006; p = 0.017) as well as death at final follow-up (ATE: 0.009; p = 0.025). The ATE was similar between CDT and MT with regard to GIB (p = 0.097) at index admission as well as unplanned 6-month readmission (p = 0.10), ICH (p = 0.11), and recurrent PE (p = 0.39) at 6 months. CONCLUSION: MT was associated with higher rates of mortality, DOTH, ICH, and total cost at index admission as well as GIB, blood transfusions, and mortality at 6 months. MT was associated with similar rates of GIB at index admission, as well as unplanned readmission, ICH, and recurrent PE at 6 months.