Association of advanced therapies for intermediate- to high-risk pulmonary embolism with improved right ventricular function on outpatient follow-up among survivors.

BACKGROUND

The impact of catheter-directed thrombolysis (CDT), catheter-directed embolectomy (CDE) and surgical pulmonary embolectomy (SPE) on long term RV function among patients with acute PE remains unclear. We investigated the association of receipt of advanced therapies with echocardiographic parameters of RV function at outpatient follow-up among survivors of acute PE.

METHODS

A retrospective cross-sectional study was performed on all patients with acute PE, who were managed in the Mount Sinai Health System (New York, NY) by PERT between January, 2021 and December, 2023, and had baseline & follow-up echocardiography performed. Non-parametric propensity score matching was performed in R using the MatchIt package. A propensity score was calculated from six variables: age, BMI, PESI, ESC risk class, Composite PE Shock score and need for systemic thrombolysis. Multivariable regression models were fitted within the propensity score matched sample incorporating matching variables as interaction factors for a doubly robust estimate. Marginal means and marginal odds ratios were computed using "ATE" (average treatment effect) as the target estimand along with calculation of cluster-robust standard errors. P-values were adjusted for multiple comparisons using the Benjamini-Hochberg procedure. An adjusted p-value cut-off of 0.05 was chosen for statistical significance.

RESULTS

A total of 122 patients (70 male) were included with median age 64.4 years, median PESI score 86 points and ESC risk group intermediate-low (26 [21.3%]), intermediate-high (76 [62.3%]) and high (20 [16.4%]) risk respectively. CDE, CDT and SPE were performed in 21 (17.2%), 11 (9.0%) and 11 (9.0%) cases. In matched analyses, receipt of any advanced therapy (compared to anticoagulation alone) was associated with increased RVOT VTI (4.6 cm; p = 0.009) and RV Ś (2.0 cm/s; p = 0.006) as well as higher odds of TR grade improvement (marginal OR: 3.0; p = 0.002).

CONCLUSION

Receipt of advanced therapies for acute PE was associated with statistically significant improvement in echocardiographic parameters of RV function at outpatient follow-up (median 26 weeks) among survivors of acute PE compared to systemic anticoagulation alone. Given the retrospective, non-randomized design, modest sample size, and use of surrogate endpoints, these findings should be considered hypothesis-generating and warrant confirmation in prospective studies incorporating clinical, functional, and patient-centered outcomes.