Outcomes in Patients With Pulmonary Embolism Treated With Mechanical Thrombectomy or Anticoagulation Alone

Abstract

Background

Pulmonary embolism (PE) is a leading cause of cardiovascular death; little data exist on whether mechanical thrombectomy confers a mortality benefit. Using a retrospective review, 311 consecutive patients with PE who underwent aspiration thrombectomy were compared to 309 propensity score–matched patients with PE treated with anticoagulation alone.

Methods

Using a retrospective review, we identified 311 consecutive patients with PE who underwent mechanical thrombectomy along with standard of care; we then identified 1841 patients admitted with a primary diagnosis of PE and used propensity score matching to identify 309 patients with similar pulmonary embolism severity index (PESI) scores and variables. We then evaluated 2-year outcomes between the 2 groups.

Results

Of the 311 patients treated with thrombectomy, 262 were at elevated risk by the European Society of Cardiology (ESC) stratification, 261 had a positive simplified pulmonary embolism severity index (sPESI) and 208 were of PESI class III or higher. Of the 309 patients treated with anticoagulation alone, 261 had elevated risk by ESC stratification, 257 had a positive sPESI, and 201 were PESI class III or higher. When all patients were evaluated, there was a mortality benefit starting at 30 days in patients undergoing thrombectomy; when patients with metastatic cancer were excluded, the mortality benefit was only seen in higher-risk patients. Low-risk patients with or without right ventricular strain had similar mortality whether managed with thrombectomy or anticoagulation alone, with numerically more significant bleeding, stroke, and recurrent pulmonary emboli.

Conclusions

In this single-center, retrospective review, patients with PE who were of ESC high risk and who underwent aspiration thrombectomy with a FlowTriever System (Inari Medical) had a statistically significant reduction in mortality compared to a propensity score–matched group treated with anticoagulation alone; separation in mortality curves continued at 2 years. Our findings also suggest that low-risk patients perform equally well with or without thrombectomy but incur numerically more bleeding events, stroke, and recurrent pulmonary emboli.