The mortality rates among patients with high-risk pulmonary embolism (PE) are alarmingly high, especially in those experiencing hemodynamic collapse. A retrospective analysis of the Pulmonary Embolism Response Team (PERT) Consortium Registry revealed that in-hospital mortality was over five times more frequent in high-risk PE patients compared to intermediate-risk PE patients. Additionally, the risk for major bleeding was significantly higher in high-risk PE patients. While this study sheds light on the short-term outcomes of PE patients, there are several areas that require further examination and improvement.
The retrospective analysis confirmed that high-risk PE patients are the primary drivers of short-term mortality in hospitalized PE patients. However, it is noteworthy that the overall mortality rate observed in this study was lower than previous reports. This could be attributed to several factors, including a more comprehensive capture of the high-risk spectrum in the registry, advancements in PE care technology, and improved care delivery methods in experienced PERT centers.
PE continues to be a leading cause of cardiovascular death in the United States, emphasizing the need for better risk assessment models. The findings of this study should propel researchers to develop universally accepted definitions for high-risk PE and explore new metrics to predict efficacy and patient outcomes. Such metrics may include durable changes in hemodynamics, metabolic measures of tissue perfusion, and echocardiographic and proteomic-based predictors of survival and myocardial recovery.
Multivariable regression analysis identified several factors associated with in-hospital mortality in PE patients. The use of vasopressors, extracorporeal membrane oxygenation (ECMO), the presence of identified clot-in-transit, and malignancy were found to significantly increase the risk of death during hospitalization. These findings highlight the importance of recognizing and managing these factors to improve patient outcomes.
Patients presenting with catastrophic PE experienced significantly higher in-hospital mortality compared to their non-catastrophic counterparts. Catastrophic PE cases also necessitated more frequent use of advanced interventions such as ECMO and systemic thrombolysis. These findings underscore the urgent need for early recognition and targeted interventions in patients with signs of impending cardiac arrest or those experiencing cardiac arrest.
The study utilized data from the PERT Consortium Registry, which may have excluded patients who were admitted for PE but did not receive consultations associated with the registry. This could limit the generalizability of the findings to the entire PE population. Furthermore, the registry data may not accurately reflect the length of stay and intensive care unit utilization, as patients receiving advanced therapies may have had shorter hospital stays.
The retrospective analysis of the PERT Consortium Registry provides valuable insights into the mortality rates and risk factors associated with high-risk PE. However, further research is needed to refine risk assessment models, establish universally accepted definitions for high-risk PE, and explore novel metrics to predict patient outcomes. This critical analysis underlines the need for ongoing efforts to improve the care and management of PE patients, ultimately reducing mortality rates and improving patient outcomes.