RS31 - Pre-existing Cancer Is Associated With Increased Mortality After Mechanical Thrombectomy for Acute Pulmonary Embolism

Objectives: Active malignancy is a well-established risk factor for venous thromboembolism; however, its impact on outcomes following catheter-based therapies for acute pulmonary embolism (PE) remains incompletely defined. This study evaluated the association between pre-existing cancer and mortality following catheter-based clot removal for acute PE.

Methods: We performed a retrospective review of all patients who underwent mechanical thrombectomy (MT) or catheter-directed thrombolysis (CDT) for acute PE at our institution between 2021 and April 2025. Patients were stratified based on the presence of an active cancer diagnosis at the time of intervention, irrespective of cancer type or location. The primary outcome was 30- day mortality. Secondary outcomes included in-hospital and one-year mortality, PE recurrence, and chronic thromboembolic pulmonary hypertension (CTEPH). Subgroup analyses were performed according to treatment modality.

Results: A total of 717 patients were included, of whom 215 (30%) had active cancer. The overall mean age was 62.8 ± 15.3 years. Compared with non-cancer patients, those with cancer were older (70 ± 11 vs. 60 ± 16 years, p< 0.001), less likely to be active smokers (5% vs. 14%, p< 0.001), and more likely to have undergone recent surgery (32% vs. 19%) or have concurrent deep vein thrombosis (80% vs. 72%, p=0.024). Most patients in both groups had intermediate–high-risk PE (83% vs. 74%), while high-risk PE was less frequent among cancer patients (3% vs. 7%, p=0.005). There were no significant differences in prior PE, central thrombus burden, procedural technique, median procedure duration (65 minutes; IQR 45–85), or technical success (95% vs. 94%).
Cancer patients experienced higher in-hospital mortality (5.2% vs. 1.6%) and 30-day mortality (8.8% vs. 2.2%). At one year, rates of PE recurrence (3.3% vs. 2.4%) and CTEPH (3.7% vs. 3.2%; p=0.72) were similar between groups. On stratified analysis, active cancer was associated with increased mortality following MT (OR 4.5; 95% CI 1.8–11.5; p< 0.001) but not CDT (p=0.76). This association persisted on multivariable analysis (adjusted OR 5.0; 95% CI 2.1–12.1; p< 0.001).

Conclusions: Pre-existing cancer is associated with a fivefold increase in 30-day mortality following mechanical thrombectomy for acute pulmonary embolism. These findings suggest that alternative treatment strategies, including catheter-directed thrombolysis or anticoagulation alone, may warrant consideration in this high-risk population. Prospective studies are needed to better define optimal treatment selection.

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