Utilization patterns in catheter-directed therapies in intermediate- and high-risk pulmonary embolism: A nationwide analysis.

Background: Catheter-based therapies (CBT), including both catheter-directed thrombolysis (CT) and mechanical thrombectomy (MT), are current treatments for intermediate- and high-risk pulmonary embolism (PE). Although the safety and efficacy of CT and MT have previously been explored, limited studies have investigated utilization patterns. This study aims to examine the trends and correlations between CT and MT use and various clinical patient factors.

Methods: Retrospective cohort analysis of data from the 2017 to 2021 National Inpatient Sample (NIS), the largest publicly available database of hospitalized patients in the United States, focusing on adult patients admitted with a diagnosis of pulmonary embolism. Using demographic and clinical variables extracted from the NIS, we evaluated the factors that affect the use of CT and MT.

Results: 1,983,074 cases of pulmonary embolism were identified in patients 18 years and above. 63,205 received CBT (3.19 %), of which 23,930 (37.86 %) received MT, 36,470 (57.7 %) received CT, and 2805 (4.43 %) received both. The proportion of CBT that was MT increased from 14.1 % in 2017 to 68.7 % in 2021, while the proportion of CT decreased from 85.9 % in 2017 to 31.3 % in 2021. In the multivariate analysis, patients 65 years and older (aOR 1.07, p < 0.001) and those with saddle pulmonary embolism (aOR 1.29, p < 0.001) and sicker patients, such as those with acute kidney injury (aOR 1.305, 95 % CI 1.255-1.356, p < 0.001) and acute myocardial infarction (aOR 1.298, 95 % CI 1.232-1.367, p < 0.001), were more likely to receive MT than CT. However, in 2021, when MT became the main CBT, MT was no longer associated with older or sicker patients. In addition, compared to rural hospitals, patients in urban non-teaching hospitals (aOR 1.317, 95 % CI 1.191-1.456, p < 0.001) and urban teaching hospitals (aOR 2.024, 95 % CI 1.843-2.223, p < 0.001) were more likely to receive MT than CT. Furthermore, patients in medium-sized (aOR 1.078, 95 % CI 1.022-1.136, p = 0.005) or large-sized hospitals (aOR 1.516, 95 % CI 1.445-1.590, p < 0.001) were more likely to receive MT than CT compared to those in small-sized hospitals.

Conclusion: MT became the primary form of CBT in patients with pulmonary embolism in 2021, although its use in this condition remains low. Before 2021, MT was mainly used for sicker patients and those with co-morbidities, but that changed when it became the predominant CBT.