Outcomes of Escalation of Care Versus Standard Anticoagulation for Intermediate-High RIsk Pulmonary Embolism: An Experienced PERT Approach

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Conference Proceeding

Publication Date


Publication Title

Jouranl of the Society for Cardiovascular Angiography & Interventions


Background: The optimal management of intermediate-high risk (IHR) pulmonary embolism (PE) is unknown. Recent data suggest a benefit of escalation of care (EOC) strategies, traditionally reserved for select high-risk PE cases, over standard anticoagulation (SAC). Methods: Patients with IHR-PE from our institution’s Pulmonary Embolism Response Team (PERT) database were retrospectively classified into 2 groups: EOC (by thrombolytic therapy [TT] or mechanical thrombectomy [MT]) and SAC. Markers of right ventricular (RV) dysfunction and hemodynamic and clinical outcomes were compared. Results: We included 636 consecutive patients, of which 301 (47.3%) underwent EOC. EOC therapies included MT in 170 (26.7%) and TT in 131 (20.6%) others (systemic thrombolysis in 53 [8.3%] and catheterdirected thrombolysis in 78 [12.3%] cases). At baseline, the EOC group had more severe RV strain (RV:LV ratio 1.6 vs. 1.2, p<0.0001), higher serum troponin I (0.35 vs. 0.08 ng/ml, p<0.0001), greater severity of illness (HR 10017 bpm vs. 8820 bpm, p<0.0001), worse hypoxemia (SpO2 at PERT consult 933 vs. 963%, p¼0.016), and were far more likely to have proximal clot burden including saddle and large bilateral main PA thrombi (87.4 vs. 31.7%, p<0.0001). There were no procedural catheter-based complications in those undergoing MT or CDL. The EOC group had lesser major bleeding (7.0 vs. 11.6%, p¼0.044) and superior clinical outcomes and survival compared to SAC (Figure). Conclusions: EOC strategies for IHR-PE are associated with superior outcomes over SAC when patient selection is performed using an experienced PERT approach.




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SCAI Society for Cardiovascular Angiography and Interventions 2023 Scientific Sessions, May 18-20, 2023, Phoenix, AZ