RETRACTED: 8 F Catheter Percutaneous Mechanical Thrombectomy Plus Anticoagulation Versus Anticoagulation Alone in Intermediate-High Risk Acute Pulmonary Embolism: A Multicenter Real-World Study on Long-Term Complications, Right Heart Function, and Quality of Life.

BACKGROUND

Intermediate-high risk acute pulmonary embolism (PE) carries a significant long-term burden of post-thrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension (CTEPH). Standard anticoagulation does not actively resolve obstructive thrombi, and systemic thrombolysis is limited by high bleeding risk. While percutaneous mechanical thrombectomy (PMT) offers rapid thrombus removal, robust multicenter evidence regarding its efficacy in preventing long-term complications is scarce, leading to its current class IIb recommendation in major international guidelines (2022 ESC, 2024 AHA).

AIMS: To compare the long-term complications, right heart function, and quality of life between patients with intermediate-high risk acute pulmonary embolism treated with 8 F catheter percutaneous mechanical thrombectomy plus anticoagulation versus anticoagulation alone.

OBJECTIVES

This study sought to evaluate whether 8 F catheter simple aspiration PMT combined with standard anticoagulation, compared to anticoagulation alone, improves long-term outcomes-including PTS, CTEPH, right heart function, and quality of life-in patients with intermediate-high risk acute PE.

METHODS

In this multicenter, retrospective cohort study, we enrolled 426 patients with intermediate-high risk acute PE from 10 regional tertiary centers (2019-2023). After 1:1 propensity score matching (PSM) to balance baseline characteristics, patients were allocated into a PMT plus anticoagulation group (n = 182) and an anticoagulation-alone group (n = 244). Primary endpoints were the incidence of PTS at 12 months (diagnosed via modified Villalta scale) and CTEPH at 24 months (confirmed by right heart catheterization). Secondary endpoints included right ventricular ejection fraction (RVEF), SF-36 quality of life scores, and adverse events (all-cause mortality, PE recurrence, major bleeding) at 24 months.

RESULTS

After a median follow-up of 24 months, the PMT group demonstrated significantly lower incidences of 12-month PTS (15.2% vs. 34.8%; adjusted HR = 0.32, 95% CI: 0.19-0.54; p < 0.001) and 24-month CTEPH (1.3% vs. 5.6%; adjusted HR = 0.25, 95% CI: 0.11-0.57; p = 0.001). The PMT group also exhibited superior improvement in RVEF at 24 months (from baseline 36.2% ± 5.7% to 58.2% ± 6.3% in the PMT group vs. from baseline 35.8% ± 6.1% to 46.3% ± 6.1% in the control group; between-group p < 0.001) and all core domains of the SF-36 at 24 months (all p < 0.001). Critically, the two groups had comparable rates of all-cause mortality (2.7% vs. 3.7%, p = 0.518), PE recurrence (2.2% vs. 2.9%, p = 0.632), and major bleeding (3.3% vs. 2.9%, p = 0.806).

CONCLUSION

In patients with intermediate-high risk acute PE, 8 F catheter PMT combined with anticoagulation significantly reduces the risks of PTS and CTEPH, enhances right ventricular recovery, and improves quality of life, without increasing adverse events. These compelling real-world findings challenge the current guideline positioning (e.g., 2022 ESC, 2024 AHA) that classifies PMT as a class IIb rescue therapy and strongly support its consideration as a first-line treatment strategy for this patient population.