Underuse of reperfusion therapy with systemic thrombolysis in high-risk acute pulmonary embolism in a Portuguese center

Introduction: Reperfusion therapy is generally recommended in acute high -risk pulmonary embolism (HR -PE), but several population -based studies report that it is underused. Data on epidemiology, management and outcomes of HR -PE in Portugal are scarce. Objective: To determine the reperfusion rate in HR -PE patients, the reasons for nonreperfusion, and how it influences outcomes. Methods: In this retrospective cohort study of consecutive HR -PE patients admitted to a thromboembolic disease referral center between 2008 and 2018, independent predictors for non-reperfusion were assessed by multivariate logistic regression. PE -related mortality and long-term MACE (cardiovascular mortality, PE recurrence and chronic thromboembolic disease) were calculated according to the Kaplan -Meier method. Differences stratified by reperfusion were assessed using the log -rank test. Results: Of 1955 acute PE patients, 3.8% presented with hemodynamic instability. The overall reperfusion rate was 50%: 35 patients underwent systemic thrombolysis, one received first -line percutaneous embolectomy and one rescue endovascular treatment. Independent predictors of non-reperfusion were: age, with >75 years representing 12 times the risk of non -treatment (OR 11.9, 95% CI 2.7-52.3, p=0.001); absolute contraindication for thrombolysis (31.1%), with recent major surgery and central nervous system disease as the most common reasons