1430: SYSTEMIC THROMBOLYSIS VS CATHETER-DIRECTED INTERVENTION FOR PULMONARY EMBOLISM: A MULTI-CENTER STUDY

Introduction: Systemic thrombolysis (ST) and catheter-directed interventions (CDI) are used in patients with pulmonary embolism (PE) requiring reperfusion therapy. Both improve outcomes in select patients but also carry a risk of complications. Limited outcome and complication data exist for ST vs. CDI. We hypothesized that these two modalities result in similar clinical outcomes and complications. Methods: This inverse probability of treatment weighted (IPTW), multi-center, retrospective study compared outcomes and complications of patients hospitalized (2013 - 2023) with PE at three metropolitan referral centers of a single healthcare system who were treated with ST or CDI. Results: 316 patients were treated with ST and 285 with CDI. After IPTW, the median age in both groups was 64 years. The proportions of submassive and massive PE were 81% and 18%. Hospital (5.2% vs. 3.0%, p = 0.19) and 1-yr (10.4% vs. 9.3%, p = 0.70) mortality, length of stay (3.27 vs. 3.32 days, p = 0.48), 30-day readmissions (9.4% vs. 7.4%, p = 0.45), and incidence of minor (6.0% vs 9.9%, p = 0.090), major extracranial (4.8% vs 2.0%, p = 0.072), or intracranial (0.8% vs 0.7%, p = 0.972) hemorrhage did not differ between CDI and ST, respectively. Post-intervention hypotension (6.9% vs. 2.3%, p = 0.01) and cardiac arrest (4.3% vs. 0.8%, p = 0.001) occurred more frequently in the CDI group. The need for escalation of care was similar between the two groups, with 3.7% of ST patients requiring subsequent CDI, and 4.0% of CDI patients requiring subsequent ST. There was no significant difference in patients requiring escalation to ECMO (1.2% vs. 0.4%, p = 0.30). Conclusions: In this multi-center study, ST and CDI resulted in similar mortality, overall complications, and escalation of care among patients requiring reperfusion therapy for PE. Future prospective studies are needed to confirm these results, further evaluate outcomes such as cardiac arrest, and to compare the cost-effectiveness of these two interventions.