Impact of reperfusion therapies on clot resolution and long-term outcomes in patients with pulmonary embolism

Objective Major progress in reperfusion strategies has substantially improved the short-term outcomes of patients with pulmonary embolism (PE), however, up to 50% of patients report persistent dyspnea after acute PE. Methods A retrospective study of the pulmonary embolism response team (PERT) registry and included patients with repeat imaging at 3 to 12 months. The primary outcome was to determine the incidence of residual pulmonary vascular obstruction (RPVO) following acute PE. Secondary outcomes included the development of PE recurrence, right ventricular (RV) dysfunction, chronic thromboembolic pulmonary hypertension (CTEPH), readmission, and mortality at 12 months. Results A total of 382 patients were included and 107 patients received reperfusion therapies followed by anticoagulation. Patients who received reperfusion therapies including systemic thrombolysis, catheter-directed thrombolysis and mechanical thrombectomy presented with a higher vascular obstructive index (VOI, 47% vs 28%, p<0.001) and signs of right heart strain on echocardiogram (81% vs 43%, p<0.001) at the time of diagnosis. A higher absolute reduction in VOI (45% vs 26%, p<0.001, 95% CI 14.0-25.6), greater improvement in RV function (82% vs 65%, p=0.021), lower 12-month mortality rate (2% vs 7%, p=0.038) and readmission rate (33% vs 46%, p=0.031) were observed in the reperfusion group. No statistically significant differences were found between groups in the development of CTEPH (8% vs 5%, p=0.488) and PE recurrence (8% vs 6%, p=0.646). Conclusions We observed a favorable survival and greater improvement in clot resolution and RV function in patients treated with reperfusion therapies.