Short-Term Clinical Outcomes of Acute Pulmonary Embolism Patients Treated With Computer Assisted Vacuum Thrombectomy With sPESI ≥1 and sPESI 0: STRIKE-PE Interim Analysis

Monday, March 31, 2025

4:12 PM – 4:21 PM CT

Location: Music City Center, 201 AB

Presenting Author(s)

John Moriarty, MD, FSIR (he/him/his)

Professor
UCLA, United States

Author/Co-author(s)

Brian J. Schiro, MD

Vascular and Interventional Radiologist
Miami Cardiac & Vascular Institute / Radiology Associates of South Florida, United States
SD

Suhail Y. Dohad, MD, MBBS

Cardiology Specialist
Cedars-Sinai Medical Center, United States
HT

Houman Tamaddon, MD

Vascular Surgeon and Endovascular Specialist
University Hospital, United States
HD

Hugh Davis, MD

Interventional Radiologist
University of Florida College of Medicine - Shands, United States
DS

David M. Shavelle, MD

Director, Interventional Cardiology
MemorialCare Heart & Vascular Institute, United States
GC

George S. Chrysant, MD

Chairman, Department of Cardiology
INTEGRIS Baptist Medical Center / INTEGRIS Cardiovascular Physicians, United States
EI

Elias A. Iliadis, MD, RPVI

Interventional Cardiologist
Cooper University Hospital, United States
DD

David J. Dexter, II, MD, RPVI

Vascular Surgeon
Sentara Vascular Specialists, United States
JC

Juan J. Ciampi Dopazo, MD

Vascular and Interventional Radiologist
Hospital Universitario Virgen de las Nieves in Granada, Spain
Andrew Holden, FRANZCR

Associate Professor
Aukland District Health Board / Auckland Hospital, New Zealand
FW

Frances Mae West, MD, MS, FACP

Assistant Professor, Associate Program Director, Pulmonary & Critical Care Fellowship
Thomas Jefferson University, United States
WK

W. Brent Keeling, MD

Associate Professor
Emory University Hospital, United States
AS

Andrew S. P. Sharp, MD, MBBS

Professor of Cardiology
University College Dublin, Ireland
IW

Ido Weinberg, MD, MS

Associate Professor
Massachusetts General Hospital, United States

Purpose:

The simplified pulmonary embolism severity index (sPESI) stratifies acute pulmonary embolism (PE) patients into those with a 30-day mortality risk that is high (sPESI ≥1; predicted rate of 10.9%) vs low (sPESI 0; predicted rate of 1.0%). This subgroup analysis examined outcomes of patients with acute PE treated within the STRIKE-PE study with computer assisted vacuum thrombectomy (CAVT; Penumbra Inc, Alameda, CA) to evaluate whether sPESI status influenced outcomes.

Materials and Methods:

STRIKE-PE is a prospective, international, multicenter study enrolling up to 1500 patients with acute PE with a right ventricle/left ventricle (RV/LV) ratio of ≥0.9 and who are treated with CAVT. Outcomes for the first 300 patients are reported on the basis of their sPESI score (sPESI ≥1, n = 245; sPESI 0, n = 55).

Results: At baseline, patients with sPESI ≥1 were older (63.1 y vs 52.9 y, P < .001), had a higher modified Miller score (14.6 vs 13.4, P = .041), had a higher heart rate (99.3 bpm vs 91.4 bpm, P < .001), and had a higher rate of clot in the main pulmonary artery (19.2% vs 7.3%, P = .034) than patients with sPESI 0. No significant difference was detected between the groups for their ESC risk stratification or baseline RV/LV ratio.

Improvement in RV/LV ratio from baseline to 48 hours postprocedure (primary effectiveness endpoint) was similar for patients with sPESI ≥1 and sPESI 0 (∆ 26.9% and ∆ 26.5%, P = .869). Improvement in baseline heart rate, indicated by reduction, at 48 hours postprocedure was greater for patients with sPESI ≥1 than for patients with sPESI 0 (∆ 12.7 bpm vs ∆ 5.4 bpm, P = .002). Their rates of composite major adverse events (MAEs) within 48 hours (primary safety endpoint) were similar (2.4% and 0%, P = .241), as were their 30-day all-cause mortality rates (1.2% and 0%; P = .410).

Median postprocedure intensive care unit length of stay was similar between groups, as was the incidence of recurrent PE at 30 days. From baseline to discharge, both groups experienced similar improvement in their Borg dyspnea scale.

Conclusion:

In this interim analysis of STRIKE-PE, patients who underwent CAVT for acute PE demonstrated a similar MAE rate in addition to similar improvements in RV/LV ratio and dyspnea score irrespective of whether their sPESI was elevated. This was despite the fact that patients with an elevated sPESI had radiographic and clinical markers of increased severity. Furthermore, objective clinical outcomes after CAVT were excellent, with a low 30-day all-cause mortality rate of 1.2% for patients with an elevated sPESI.