266 - Obesity, Endovascular Intervention, and In-Hospital Mortality in Acute Pulmonary Embolism: A Retrospective Analysis of Independent Predictors

Purpose: We aimed to determine if obesity was associated with different rates of in-hospital mortality and intervention in acute pulmonary embolism (PE) patients treated at a large midwestern medical center with a dedicated Pulmonary Embolism Response Team (PERT).

Materials and Methods: This retrospective, single-center study included 549 intermediate-high and high-risk PE patients who received PERT consultation during a 4-year period from 2021 to 2025. Obesity was defined as a BMI value greater than 30 kg/m². Patients were separated by obesity status, and analysis was conducted for demographic data, hospital course, and outcomes at discharge. Outcomes included in-hospital mortality, discharge location, and need for oxygen at discharge. Hospital course variables include cardiac arrests, bleeds, transfusions, and length of total and ICU stay. Patients were further subdivided by treatment categories of intervention and anticoagulation. Intervention included both mechanical thrombectomy and catheter-directed thrombolysis.

Results: 549 patients were included in this study, 255 (46.44%) of whom were obese. In-hospital mortality rate was 20.41% and 13.33% in non-obese and obese patients, respectively (p=0.03). However, obesity was not an independent risk factor for mortality (OR: 1.53, 95% CI: 0.72-3.22, p=0.29). 63 (24.71%) obese patients received intervention compared to 44 (14.97%) non-obese patients (p=0.004). The strongest predictive factor of receiving intervention was obesity (OR: 2.05, 95% CI: 1.25-3.44, p=0.005). Other associated factors of being placed in the intervention treatment group were a higher Bova score and cardiac arrest; however, interaction data between obesity and demographic factors, Bova score, cardiac arrest, and comorbidity index were nonsignificant.

Conclusion: Our results suggest that although mortality rates were lower in obese patients, obesity itself is not an independent predictor of mortality. Conversely, obesity served as an independent predictor of receiving intervention.