Mortality in patients undergoing catheter-based therapy vs. anticoagulation alone for intermediate-high risk pulmonary embolism

Introduction Pulmonary embolism is a common and potentially fatal medical condition. Current guidelines recommend therapeutic anticoagulation for intermediate-high risk pulmonary embolism as a first-line strategy. However, it is unclear whether these patients may benefit from interventional treatments, such as catheter-based thrombectomy or catheter-based thrombolysis, compared to anticoagulation alone regarding mortality. Our aim was to gain insight into optimal treatment strategies of intermediate-high risk PE patients and to evaluate outcomes of different management strategies with regard to all-cause mortality. Methods We retrospectively evaluated a total of 236 patients, 133 patients undergoing catheter-based thrombectomy or catheter-based thrombolysis (interventional group) and 103 patients receiving anticoagulation alone (conservative group) at our institution between 2003 and 2024. All patients were classified as intermediate-high risk. The primary endpoint was all-cause mortality. Results The overall mortality for all patients with intermediate-high risk pulmonary embolism was 12.0% at 12 months. Depending on the treatment approach, all-cause mortality after 12 months occurred in 14 of 103 patients (14.0%) in the conservative group and in 14 of 133 patients (11.0%) in the interventional group which did not significantly differ ( p = 0.150). Discussion In patients with acute intermediate-high risk pulmonary embolism catheter-based treatment did not show a significant reduction in mortality within 12 months compared to anticoagulation alone.