TOPLINE:
1 in 5 patients with high-risk pulmonary embolism (PE) and more than 2 in 5 with catastrophic PE with hemodynamic collapse die in the hospital, a large contemporary analysis showed.
METHODOLOGY:
- Researchers evaluated contemporary care patterns and outcomes of high-risk PE using data from the Pulmonary Embolism Response Team (PERT) Consortium Registry, a prospective collaboration of 35 centers in the United States with dedicated multidisciplinary PERTs.
- The cohort included 2976 patients with intermediate-risk PE and 1442 with high-risk PE. The high-risk PE group included 197 patients with catastrophic PE with hemodynamic collapse.
- The co-primary endpoints were in-hospital mortality and major bleeding; multivariable regression analysis was used to identify baseline factors independently associated with the primary endpoints.
TAKEAWAY:
- Patients with high-risk PE were more likely than those with intermediate-risk PE to undergo advanced therapies (41.9% vs 30.2%), including systemic thrombolysis, surgical embolectomy, and mechanical circulatory support, with no difference in catheter-based therapies.
- The risk for in-hospital major bleeding increased proportionally with the severity of PE presentation.
- In-hospital mortality was 20.6% in high-risk PE vs 3.7% in intermediate-risk PE; it was 42.1% in catastrophic high-risk PE with hemodynamic collapse vs 17.2% in noncatastrophic high-risk PE.
- Factors associated with in-hospital mortality were vasopressor use (odds ratio [OR], 4.56), extracorporeal membrane oxygenation use (OR, 2.86), identified clot-in-transit (OR, 2.26), and malignancy (OR, 1.70).
IN PRACTICE:
"Disappointingly, our data continue to show significant mortality in patients experiencing high-risk PE despite technological advancements in catheter-based and surgical strategies, as well as the larger national implementation of PERT teams," the authors concluded. "This study underlines the need for a larger societal role and a call to action to produce more high-quality research in this devastating condition, as well as consideration of standardized practices across the nation, given that similar efforts in the past have led to decreased mortality in other cardiovascular emergencies such as acute myocardial infarctions and stroke."
SOURCE:
The study, with first author Taisei Kobayashi, MD, University of Pennsylvania Perelman School of Medicine, Philadelphia, and accompanying editorial were published online on January 1, 2024, in the Journal of the American College of Cardiology.
LIMITATIONS:
The findings are limited to the experience of mainly tertiary care centers with active PERTs. The designation of catastrophic PE was interpreted based on local PERT centers' discretion and could not be individually adjudicated. Factors associated with in-hospital mortality should be viewed as hypothesis-generating, with confirmation needed.
DISCLOSURES:
Funding was provided by a grant from the nonprofit PERT consortium. Several authors disclosed relationships with industry. A complete list of author disclosures is available with the original article.
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