Sex Differences in Advanced Therapeutic Interventions for Intermediate- and High-Risk Pulmonary Embolism

Purpose

Advanced interventions are increasingly used to treat intermediate- and high-risk acute pulmonary embolism (PE). While sex-based differences exist in treatment of other diseases, it is unknown whether these disparities extend to PE.

Methods

This is a secondary analysis of a prospective cohort study of adult patients diagnosed with radiographically confirmed intermediate- and high-risk acute PE at a tertiary hospital between 1/1/2012 and 12/31/2021 for whom the PE Response Team was activated. Primary outcome was receipt of any advanced intervention. Descriptive and inferential analyses using Chi-square tests, t tests, and logistic regression were performed to evaluate for factors associated with the primary outcome.

Findings

We analyzed 902 patients, of whom 439 (49%) were female. Although women were more likely to present with right heart strain on echo (78.6% vs 71.1% P = 0.012) and elevated NT-proBNP (69.2% vs 55.7% P < 0.001), there was no significant sex-based difference in clinical PE severity, defined as intermediate- versus high-risk, at presentation. Primary outcome did not differ significantly by sex (18.7% vs 23.5% P = 0.129). In multivariate models, high-risk PE decreased odds of receiving an advanced therapy (0.50 [0.31, 0.79] P = 0.003), while receiving assisted ventilation (4.70 [2.90, 7.62], P < 0.001) and full code status (4.18 [1.60, 10.91], P = 0.003) increased odds.

Implications

This study adds to the scant literature on sex differences in interventions for acute PE. Significant baseline variation exists between female and male patients presenting with acute PE. Clinical factors were predictive of receiving advanced PE therapies, while sex was not.