Introduction
Pulmonary embolism (PE) is one of the most frequent cardiovascular diseases worldwide and a major cause of cardiovascular mortality. Numerous catheter-directed strategies for patients with intermediate-high or high-risk PE are currently available, but little is known about possible gender differences in treatment outcomes.
Methods
Between October 2017 and October 2023, we performed ultrasound-assisted catheter-directed (UADCT) or mechanical thrombectomy using either EKOS® (Boston Scientific) or FlowTriever® (INARI Medical) in patients with intermediate-high or high-risk PE who were submitted to our department. Both procedures were performed within the first 24 hours after admission in our catheter lab. Patients received unfractionated heparin peri- and postinterventional and were then switched to other anticoagulants after 24 hours.
Results
Between October 2017 and October 2023, we performed UACDT or mechanical thrombectomy in 54 female (49 ± 35 years, BMI 35.2 ± 7.7 kg/m²) and 57 male patients (65 ± 15 years, BMI 30.9 ± 8.7 kg/m², both n.s.).
Baseline NT-proBNP (4380 ± 4266 vs. 1474 ± 1215 pg/ml), TNT (118.9 ± 113.7 vs. 131 ± 81.2 pg/ml) and RV/LV ratio (1.2 ± 0.2 vs. 1.1 ± 0.2) did not differ significantly but sPAP was significantly higher in male patients (42.5 ± 13.3 vs. 60 ± 12.5 mmHg).
Postinterventional, TNT (56.6 ± 41.2 (females) and 69.1 ± 38.9 pg/ml (males)), NT-proBNP (3217 ± 2230 and 348 ± 341 pg/ml) and LV/RV ratio (0.99 ± 0.15 and 1.0 ± 0.3) remained stable, sPAP sank significantly in both groups (34 ± 10.6 and 40 ± 9.9 mmHg).
There were 6 deaths in the whole cohort (one female and 5 males), 5 due to pneumonia related sepsis and one due to influenza. 22.2 % of the female patients showed bleeding complications (BARC 2 and 3a) compared to only 8.7 % of male patients (p < 0.05), also female patients needed blood transfusion significantly more often (11.1 % vs. 3.5 %). There was no need for any intervention due to bleeding.
So far, 70 % of the female and 75 % of the male patients could be evaluated in our outpatient clinic 3 months after hospitalization.
sPAP and NT-proBNP showed a significant decreased compared to the initial evaluation but did not differ significantly between the groups, LV/RV ratio remained stable. However, female patients could manage a significantly longer distance in the 6-minute walking test (383 ± 141 vs. 300 ± 121 m).
Conclusion
Although women showed a higher complication rate periinterventional, catheter directed treatment of intermediate-high or high-risk PE is effective in both female and male patients concerning short- and mid-term outcomes. More studies concerning treatment strategies and different genders are needed to determine possible predictors for success and safety.
