Endovascular Therapy for PE: Earlier Rather than Later Treatment, as in MI and Stroke?

Patients with pulmonary embolism (PE), whether intermediate-high or high risk, may progress to right ventricular (RV) dysfunction, leading to severe hemodynamic decompensation and significantly worsened prognosis. In this context, timely reperfusion — a strategy employed in acute myocardial infarction (AMI) or stroke — remains an unresolved clinical question.

Catheter-based therapies (CBT), including catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT), have emerged in recent years as promising options. However, available evidence regarding their optimal timing remains scarce and limited.

A study published in EuroIntervention, led by Leiva et al., sought to address this uncertainty through a retrospective analysis using data from the Nationwide Readmissions Database (United States) for 2017–2020. Researchers included more than 12,000 patients with PE; 10,145 of them were classified as intermediate risk and 1992 as high risk. The cohort was divided according to the timing of the intervention: early CBT (≤1 day from admission) versus delayed CBT (>1 day).

The average patient age was 61.1 years and 47.7% of subjects were women. Delayed CBT was performed in 15.3% of cases, with 68.2% of patients treated using CDT. In intermediate-risk PE patients, early CBT was associated with a significant reduction in 90-day mortality (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.46–0.66), as well as lower rates of readmission (HR: 0.86; 95% CI: 0.78–0.95), major bleeding (odds ratio [OR]: 0.79; 95% CI: 0.73–0.87), and length of hospital stay (5.1 days vs. 7.3 days; p <0.001).

Read also: Percutaneous Treatment of Atrial Functional Mitral Regurgitation.

In the high-risk group, there was also a significant reduction in 90-day mortality (HR: 0.89; 95% CI: 0.80–0.99) and hospital stay (8.9 vs. 13.4 days; p < 0.001), although the benefits were less marked.

Additionally, when analyzing outcomes by type of intervention, early CDT showed better performance than MT in both risk groups.

Conclusions

This national retrospective analysis with a large number of subjects suggests that early application of transcatheter therapy in intermediate- or high-risk PE patients is associated with a significant reduction in 90-day mortality, hospital readmissions, and major bleeding events during hospitalization.

Reference: Leiva O, Rosovsky RP, Alviar C, Bangalore S. Early versus delayed catheter-based therapies in patients hospitalised with acute pulmonary embolism. EuroIntervention. 2025 May 5;21(9):e463-e470. doi: 10.4244/EIJ-D-24-00555. PMID: 40325984.