(1061) Comparative Efficacy of USAT vs CBT: One-Year Mortality and Bleeding Events in a Multicenter Study

Introduction: Advanced interventional techniques such as ultrasound-assisted catheter-directed thrombolysis (USAT) and catheter-based thrombectomy (CBT) have been developed to improve clinic outcomes in patients with acute pulmonary embolism (PE). In this study, we aim to compare the efficacy of USAT and CBT in terms of one-year mortality and bleeding events.

Methods: This study is a multi-center retrospective cohort study of all patients diagnosed with acute pulmonary embolism between July 2019 and December 2022. Patients were divided into two groups based on the intervention received: USAT or CBT. The decision on which intervention was to be used was at the discretion of the respective institutions' pulmonary embolism response team (PERT). Primary outcomes were one-year mortality and bleeding events. Data were extracted from electronic medical records using associated ICD codes. Statistical analysis was conducted using both Python and chatGPT and included Fisher’s exact test and logistic regression analysis.

Results: The study included 178 patients, with 72 in the USAT and 106 in the CBT group. The odds ratio (OR) for one-year mortality was 0.387 (p = 0.129), suggesting no statistically significant difference in one-year mortality between the two groups. For bleeding events, the OR was 0.288(p=0.0015), indicating a statistically significant difference in bleeding incidence, with USAT being associated with fewer bleeding events.

In the USAT cohort, significant predictors of bleeding included Troponin T (TropT) and smoking, with positive coefficients of approximately 0.65 and 0.5, respectively, indicating that higher TropT levels and smoking increased the likelihood of bleeding. Additionally, sex was a significant predictor, with a negative coefficient of approximately -0.75, indicating that females had a lower likelihood of bleeding. The model's performance, indicated by an ROC AUC of 0.87, showed excellent discrimination in predicting bleeding events.

Conclusions: This study demonstrates that USAT is associated with fewer bleeding events compared to CBT in patients with acute PE, without an increased risk of one-year mortality. The findings suggest that USAT may offer a safer alternative to CBT in terms of bleeding risk, highlighting the importance of personalized patient management in acute PE treatment.