A67-11 Catheter-Directed Thrombolysis in Recurrent Versus First-Time Pulmonary Embolism: Comparing Complications, Mortality, and Readmissions

Abstract Introduction Catheter-directed thrombolysis (CDT) has emerged as a safer interventional option for acute pulmonary embolism (APE) compared to systemic thrombolysis, with reduced rates of hemorrhage and mortality. However, comparative outcomes between first-time and recurrent APE patients undergoing CDT remain inadequately documented. This study aims to compare complications, mortality, and readmissions following CDT in recurrent versus first-time PE to provide evidence-based guidance for treatment optimization. Methods We explored the 2016-2022 Nationwide Readmissions Database(NRD) for APE admissions treated with CDT and stratified our sample by history of prior pulmonary embolism. Our cases excluded patients with COVID-19 and those younger than 18 years. We compared differences in their demographics, in-hospital complications during the index admission, and 30-day readmission rates. Adjustments were made to account for the complex design of the NRD via STATA 18.0. Results Of 37,952 patients identified, 9.27% had a history of prior PE. The groups had comparable mean age, sex distribution, and hospital status, with varying comorbidities as shown in Tables 1a-1b. Patients with first-time PE were more likely to experience in-hospital complications including sepsis, transfusion requirement, invasive mechanical ventilation, shock, acute encephalopathy, acute kidney injury, and all-cause mortality during the index hospitalization(Table 2). However, hospital length of stay and charges were similar between groups(Table 1b). Following discharge, 30-day readmission rates were comparable (6.25% vs. 6.41% for first-time versus recurrent PE, respectively; hazard ratio 0.948, 95% CI 0.765-1.17, p = 0.626). Conclusion First-time APE patients who underwent CDT reported higher rates of various in-hospital complications, and all-cause mortality, despite having comparable 30-day readmission rates. There were certain limitations to our study, such as the lack of laboratory data, imaging findings, APE severity scores on admissions, and medication history. Prospective studies with detailed clinical parameters will help validate our findings and elucidate the different causes of death. This abstract is funded by: None