Background and Aims Catheter-based therapies (CBTs) have been developed as a treatment option in patients with pulmonary embolism (PE). There remains a paucity of data to inform decision-making in patients with intermediate-risk or high-risk PE. The aim of this study was to characterize in-hospital and readmission outcomes in patients with intermediate-risk or high-risk PE treated with vs. without CBT in a large retrospective registry. Methods Patients hospitalized with intermediate-risk or high-risk PE were identified using the 2017–20 National Readmission Database. In-hospital outcomes included death and bleeding and 30- and 90-day readmission outcomes including all-cause, venous thromboembolism (VTE)-related and bleeding-related readmissions. Inverse probability of treatment weighting (IPTW) was utilized to compare outcomes between CBT and no CBT. Results A total of 14 903 [2076 (13.9%) with CBT] and 42 829 [8824 (20.6%) with CBT] patients with high-risk and intermediate-risk PE were included, respectively. Prior to IPTW, patients with CBT were younger and less likely to have cancer and cardiac arrest, receive systemic thrombolysis, or be on mechanical ventilation. In the IPTW logistic regression model, CBT was associated with lower odds of in-hospital death in high-risk [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.80–0.87] and intermediate-risk PE (OR 0.76, 95% CI 0.70–0.83). Patients with high-risk PE treated with CBT were associated with lower risk of 90-day all-cause [hazard ratio (HR) 0.77, 95% CI 0.71–0.83] and VTE (HR 0.46, 95% CI 0.34–0.63) readmission. Patients with intermediate-risk PE treated with CBT were associated with lower risk of 90-day all-cause (HR 0.75, 95% CI 0.72–0.79) and VTE (HR 0.66, 95% CI 0.57–0.76) readmission. Conclusions Among patients with high-risk or intermediate-risk PE, CBT was associated with lower in-hospital death and 90-day readmission. Prospective, randomized trials are needed to confirm these findings.

中文翻译：

---

高危或中危肺栓塞的导管治疗：死亡和再住院

背景和目的 基于导管的疗法 (CBT) 已被开发为肺栓塞 (PE) 患者的一种治疗选择。目前仍然缺乏为中危或高危 PE 患者提供决策依据的数据。本研究的目的是在大型回顾性登记中描述接受 CBT 治疗与未接受 CBT 治疗的中危或高危 PE 患者的住院和再入院结果。方法 使用 2017-20 年国家再入院数据库确定因中危或高危 PE 住院的患者。院内结局包括死亡和出血以及 30 天和 90 天的再入院结果，包括全因、静脉血栓栓塞 (VTE) 相关和出血相关的再入院。利用治疗加权逆概率 (IPTW) 来比较 CBT 和无 CBT 之间的结果。结果共纳入14 903例[2076例（13.9%）CBT]和42 829例[8824例（20.6%）CBT]高危和中危PE患者。在 IPTW 之前，接受 CBT 的患者较年轻，患癌症和心脏骤停、接受全身溶栓或接受机械通气的可能性较小。在 IPTW 逻辑回归模型中，CBT 与高风险 [比值比 (OR) 0.83，95% 置信区间 (CI) 0.80–0.87] 和中等风险 PE（OR 0.76， 95% CI 0.70–0.83）。接受 CBT 治疗的高危 PE 患者与 90 天全因 [风险比 (HR) 0.77，95% CI 0.71–0.83] 和 VTE（HR 0.46，95% CI 0.34–0.63）再入院风险较低相关。接受 CBT 治疗的中危 PE 患者与 90 天全因（HR 0.75，95% CI 0.72–0.79）和 VTE（HR 0.66，95% CI 0.57–0.76）再入院的风险较低相关。结论 在高危或中危 PE 患者中，CBT 与较低的院内死亡率和 90 天再入院率相关。需要前瞻性随机试验来证实这些发现。