OC 70.5 - Reperfusion treatment for intermediate-high risk patients with pulmonary embolism: analysis from a multicenter cohort study

Background: Intermediate-high-risk patients with acute pulmonary embolism (PE) continue to exhibit high short-term mortality. The decision to administer reperfusion therapy in these patients poses a challenging clinical dilemma and represents a focus within the PE research field.

Aims: To investigate the present status and assess the outcomes of reperfusion therapy in patients with intermediate-high-risk PE in a large-scale multicenter cohort study.

Methods: The China Pulmonary Thromboembolism Registry Study (CURES) is a multicenter, prospective registry study (NCT02943343). Intermediate-high risk PE patients enrolled between January 1, 2009 and December 31, 2021 were investigated. Baseline characteristics, treatment patterns and outcomes including death and bleeding events were recorded during hospitalization. Reperfusion treatment included intravenous thrombolysis and catheter directed therapy. Regular follow-ups were conducted in accordance with the study design, and patients with less than 30 days of follow-up were excluded from the analysis.

Results: In 7765 PE patients registered, 1034 were categorized as intermediate-high risk and 986 were ultimately included in analysis. Only 93 patients (9.4%) received reperfusion plus anticoagulation therapy, and these patients were younger and had fewer chronic cardiopulmonary diseases (Table 1). In the 30-day follow-up, only one patient (1.08%) in the reperfusion plus anticoagulation group died, while 41 patients (4.59%) died in anticoagulation only group. However, the difference lacked statistical significance. One-year mortality was also higher in anticoagulation only group compared to reperfusion plus anticoagulation group, though without statistical significance (12.9% vs 5.45%, HR 0.48, 95%CI 0.21-1.08, p=0.077) (Figure 1). Although there were more 30-days bleeding events in the reperfusion plus anticoagulation group (8.60% vs 3.36%, p< 0.021), none was major bleeding.

Conclusion(s): CURES data for intermediate-high-risk patients indicated that the reperfusion plus anticoagulation group exhibited lower short- and long-term mortality compared to the anticoagulation-only group; however, the differences did not achieve statistical significance.