Early advanced re-perfusion therapy (<24 hours) for acute pulmonary embolism was associated with higher odds of 30-day mortality compared to late therapy (OR 35.5; 95% CI 5.7-222.3; p<0.001).
Cohort (n=62)
Yes
Does early advanced re-perfusion therapy (<24 hours) improve 30-day mortality and major bleeding in patients with acute pulmonary embolism compared to late therapy?
In a retrospective propensity-matched cohort of acute PE patients, early advanced re-perfusion therapy (<24 hours) was paradoxically associated with higher 30-day mortality compared to later intervention, highlighting the need for further investigation into optimal timing and potential confounding by indication.
Effect estimate: OR 35.5 (95% CI 5.7-222.3)
p-value: p=<0.001
Abstract Rationale Acute pulmonary embolism(PE) accounts for 60,000 to 100,000 deaths in the US annually. Advanced re-perfusion therapies(ART) for acute PE are offered at centers of PE expertise. While ART is associated with immediate hemodynamic improvements, it is unclear if the timing of ART is associated with outcomes of acute PE. We examined the association between timing of ART and overall outcomes for patients with acute PE receiving PERT(PE Response Team)-guided ART. Methods We retrospectively reviewed charts of patients with acute PE managed by PERT at one of three urban teaching hospitals in the Mount Sinai Health System from January 2021 to September 2023. Early intervention was defined as a time from diagnosis of acute PE to time of starting ART procedure of less than 24 hours. ART offered to patients included catheter-directed thrombolysis, catheter-directed embolectomy and surgical embolectomy. A propensity score-matched analysis was performed using the MatchIt package for R with optimal full matching specifications. Regression models were constructed in the propensity score matched sample to assess associations between early(vs. late) intervention and overall outcomes(mortality and bleeding). Results 62 patients were included in the analysis. Median age was 60(IQR: 51‒71) years and 41.9%(n = 26) were female. Median PESI score was 72(IQR: 62‒91) points. Based on ESC risk stratification, 9(14.5%), 49(79.0%) and 4(6.4%) had intermediate low-, intermediate high- and high-risk acute PE. ART administered to patients included CDT and mechanical thrombectomy in 29.0%(n = 18) and 71.0%(n = 44) respectively. Median time from diagnosis of acute PE to initiation of ART was 15.1(IQR: 9.9‒25.3) hours. After splitting the cohort into early(n = 45, 72.6%) and late(n = 17, 27.4%) intervention groups, propensity score matching was performed on age, BMI, PESI and ESC risk group. In the propensity score-matched sample, early ART was associated with higher odds of 30-day mortality(marginal OR: 35.5; 95% confidence interval CI: 5.7‒222.3; p 0.001) but unchanged odds of 30-day major bleeding (marginal OR: 2.2; 95% CI: 0.2‒23.8; p = 0.517) or 30-day re-admission (marginal OR: 0.63; 95% CI: 0.06‒6.5; p = 0.695). 3(4.8%) had a Composite PE Shock Score(CPES) of 6, none died and 1 had early intervention. 21(33.8%) had a CPES of 5, none died and 17 had early intervention. Conclusion Receipt of ART within 24 hours of diagnosis was associated with higher odds of 30-day mortality.18/24(75%) patients with elevated CPES of 5-6 had early intervention and none died. The odds of 30-day major bleeding and 30-day re-admission were not significantly associated with timing of ART. This abstract is funded by: None
Sridhar et al. (Fri,) conducted a cohort in Acute pulmonary embolism (n=62). Early advanced re-perfusion therapy (<24 hours) vs. Late advanced re-perfusion therapy (≥24 hours) was evaluated on 30-day mortality (OR 35.5, 95% CI 5.7-222.3, p=<0.001). Early advanced re-perfusion therapy (<24 hours) for acute pulmonary embolism was associated with higher odds of 30-day mortality compared to late therapy (OR 35.5; 95% CI 5.7-222.3; p<0.001).