Trends in Catheter-Directed Therapy and In-Hospital Outcomes Among Patients with Acute Pulmonary Embolism: Insights from a Multicenter National Quality Assurance Database Registry.
Publication Title
Eur Heart J Acute Cardiovasc Care
Document Type
Article
Publication Date
12-23-2025
Keywords
washington; swedish; swedish heart
Abstract
Background: Multidisciplinary pulmonary embolism response teams (PERT) are being established in hospitals worldwide to address the increasing complexity in acute PE management.
Aim: To identify recent trends in PERT decisions regarding advanced treatment of acute severe PE.
Methods: We analysed data from the prospective multicentre PERTTM Consortium registry (years 2018-2024), focusing on catheter-directed treatment (CDT) and including systemic thrombolysis, surgical embolectomy, and extracorporeal membrane oxygenation (ECMO). An age-, sex-, and PE risk-matched population from the US Nationwide Inpatient Sample (NIS) was used for comparison.
Results: Among 11,436 patients enrolled at 51 sites (median age, 65 years; 13.7% high-risk and 62.5% intermediate-risk PE), 2,639 (23.1%) underwent CDT. Of those, 140 (5.3%) underwent catheter-directed thrombolysis without ultrasound, 851 (32.2%) ultrasound-assisted catheter thrombolysis, and 1,534 (58.1%) mechanical thrombectomy/aspiration. Systemic thrombolysis was used in 5.6%, surgical embolectomy in 1.1%, and ECMO in 1.6% of all patients. Trends of CDT increased over time (+0.36% quarterly by linear regression; P=0.002), with increase in mechanical thrombectomy (+0.83%; P< 0.001) and decrease in catheter-directed thrombolysis (-0.4%; P=0.001). Matching 10,883 patients from the PERTTM Consortium registry to the NIS population, we found a 22% (95% CI, 21-23%) standardized mean difference in CDT use, 1.3% (0.6-2.0%) lower in-hospital mortality, and 0.75 (0.2-1.3) less days of hospital stay among PERTTM Consortium registry patients.
Conclusion: In a national quality assurance database of patients with PE included in the PERT registry, the use of catheter-directed treatment increased over time. Compared with a nationwide NIS sample, these patients had lower in-hospital mortality and shorter hospital length of stay.
Keywords: advanced therapies; catheter directed treatment; pulmonary embolism; pulmonary embolism response team; systemic thrombolysis.
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Cardiology
Specialty/Research Institute
Hematology
DOI
10.1093/ehjacc/zuaf169
