C-35 | Predictors of Early vs Late Catheter Directed Embolectomy Intervention for Pulmonary Embolism

Catheter Directed Embolectomy (CDE) is a growing modality in the treatment of pulmonary embolism (PE). We aim to study the predictors of early (within 48 hours) in comparison to late (> 48hours) CDE intervention. The National Inpatient Sample database was queried from the years 2016-2019 to obtain our sample of PE admissions using appropriate ICD-10-CM codes in the primary diagnosis field. Those with concurrent ischemic stroke, limb ischemia, or coronary revascularization in the same admission were excluded and our cohort was divided into early and late intervention of CDE. Chi-square and t-test analysis were used to compare the characteristics of both groups and multivariate regression was used to derive our predictors of intervention through odds ratio (OR). 6,430 hospitalizations received CDE, of which 5,165 underwent early intervention and 1,265 underwent late intervention. Patients who got early interventions were older (62.1 ± 14.6 vs 60.6 ± 15.6, p<0.01) and had lower Charlson comorbidity index score (1.8 ± 2.1 vs 2.1 ± 2.4, p<0.01). Furthermore, patients who underwent early intervention were more likely to have needed vasopressor use (OR: 0.35, p<0.01), ECMO use (OR: 0.10, p<0.01), peripheral thrombolysis (OR: 0.72, p<0.01) and mechanical ventilation (OR: 0.62, p<0.01) than the late intervention group. In this study, ECMO, vasopressor use, and mechanical ventilation were predictors of early use of thrombectomy in PE. More data is needed to define the criteria for early use and optimum timing of thrombectomy in this critical patient population.