In-hospital outcomes among patients presenting with pulmonary embolism complicated by shock

Introduction: There is no consensus on the best management strategy for pulmonary embolism complicated by shock (PES). Thus, we compare outcomes of patients (pts) presenting with PES receiving anticoagulation (AC) alone, percutaneous thrombectomy (PT), surgical embolectomy (SE), catheter-based thrombolysis with AC (CTTA), and intravenous thrombolysis (ITT). Methods: We used the National Inpatient Sample data to obtain a representative sample of all pts admitted for PES between 2016 and 2019. Our primary outcome of interest was in-hospital death and secondary outcomes were length of stay (LOS) and total expenditure. We performed a regression analysis for each outcome of interest adjusting for sociodemographic factors, comorbidities, and other interventions such as mechanical ventilation and IVC filter use. Results: Of the 7,608 pts, the mean age was 64 and 52% were male. Most pts (78.8%) received AC alone, 10.8% received ITT, 4.3% received CTTA, 3.5% underwent PT, and 2.6% underwent SE. Overall, mortality was high at 40.8%. The highest mortality was among patients who received ITT (42.9% and 42%, respectively), compared to SE, CTTA, and PT (23.5%, 25.5%, and 35%, respectively). SE had the highest LOS and hospital cost (17.8±14.8; $478,707±448,563) compared with all other management. Compared with AC, pts undergoing CTTA, and SE had the lowest risk of in-hospital death (CTTA OR 0.54, 95%CI 0.41-0.71, p< 0.001; SE OR 0.65, 95%CI 0.45-0.92, p=0.02, respectively). Conclusions: Although hospital mortality for pts presenting with PES is high, invasive approaches are associated with lower mortality. CTTA had the lowest odds of death. More data is required to optimize outcomes for individual patients.