OC 70.2 - A ten-year experience of high-risk pulmonary embolism in a tertiary center

Background: Acute high-risk pulmonary embolism (PE), defined as presence of hemodynamic instability, confers a high mortality despite the availability of advanced therapeutic options. However, representative real-world data are lacking.

Aims: To present a ten-year experience of high-risk PE in a tertiary center.

Methods: We retrospectively evaluated all patients aged ≥ 18 years who received systemic thrombolysis, surgical thrombectomy and/or mechanical support for probable or definite high-risk PE at the University Hospitals Leuven, Belgium, from 2013 to 2022. Between-group differences were assessed using a Fisher’s exact test.

Results: From 2013 to 2022, 90 patients (47 males; mean age 66 years) presented with high-risk PE (table). Among these, 35 patients (39%) presented with a cardiac arrest. Major provoking risk factors were identified in 28 patients (31%): 12 with recent major surgery, 12 with active cancer, and 4 with both. Sixteen patients (18%) had a history of venous thrombo-embolism, with only two under therapeutic anticoagulation upon PE onset. Known inherited thrombophilia was present in 6 patients (7%).

Advanced therapies beyond anticoagulation included systemic thrombolysis (n=78), surgical thrombectomy (n=11), and extracorporeal membrane oxygenation (ECMO) (n=15), used either individually or in combination. The overall 30-day mortality was 46% (n=41) with most deaths occurring during hospitalization (n=40) (figure). There was a trend towards a higher 30-day mortality in patients presenting with cardiac arrest (20/35 (57%) vs. 21/55 (38%), two-sided p=0.088). No significant differences were observed in survival between the group treated with systemic thrombolysis alone (n=67) and the surgically treated group (n=22) (two-sided p=0.62). ISTH-defined major bleeding occurred in 24 individuals (27%), all of whom received systemic thrombolysis.

Conclusion(s): Despite the availability of various advanced treatment options, the prognosis of high-risk PE patients remains poor, even in a tertiary center. Therefore, improved management strategies are urgently needed.