In PE, Improved Survival Found for Surgery vs. Catheter-Based Interventions

Using catheter-based interventions (CBI) for acute pulmonary embolism (PE) is associated with reduced PE recurrence when compared with medical treatment, reported a study. However, the authors cautioned, the mortality rate was higher in the CBI group versus patients who were treated surgically.

This study was published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders.

“CBI has become an increasingly popular option for treating PE; however, the real benefits are unknown,” wrote the study authors.

The investigators retrospectively reviewed patients treated for acute PE between October 2015 and December 2017. Patients were aged ≥18 years. Patients treated with CBI were propensity score matched to a cohort of control subjects. Controls had either undergone surgical pulmonary embolectomy (SPE; surgical group) or had been treated without surgery or CBIs (medical group). The primary endpoint was mortality, including in-hospital and overall rates. Secondary outcomes included major bleeding, length of stay, thrombus resolution, right ventricle improvement in systolic function and dilatation, and recurrent PE.

Overall, 108 patients were evaluated. Thirty patients in the CBI group were compared with 78 controls (medical, n = 62; surgical, n = 16). At admission, patient characteristics were similar apart from body mass index, which was higher in the CBI group (P=0.03).

After treatment, the researchers reported that all groups demonstrated similar clinical severity, clot burden, right ventricle function, and biomarkers. The team noted that recurrent PE occurred less frequently in the CBI group compared with the medical group (0% vs. 6.4%), although this was the only significant difference between outcomes among the CBI and medical groups.

When compared to the surgical group, however, CBI demonstrated a markedly increased mortality rate compared with SPE, or 16.6% vs. 0%. Surgery was associated with a longer median length of hospital stay compared with CBI (7 vs. 8 days).

In summary, the authors wrote, “The use of CBI reduced the number of recurrent PE events compared with the medically treated patients; however, the mortality was higher than that in the surgical group.”