SPE-ACP showed substantially increased prevalence over time, and among advanced reperfusion therapies, favorable outcomes were observed with CDTL during 2016-2022 while CDMT may be evolving into an alternative strategy given its relatively comparable outcomes during 2020-2022.
Saddle pulmonary embolism with acute cor pulmonale (SPE-ACP) constituted 1.7% of all pulmonary embolisms and showed a substantially increased prevalence over time.
Systemic fibrinolysis (SF) was associated with higher risks of major bleeding and in-hospital mortality compared to catheter-directed thrombolysis (CDTL) and catheter-directed mechanical thrombectomy (CDMT).
Catheter-directed thrombolysis (CDTL) was associated with lower transfusion risk and higher rates of discharge to home compared to other advanced reperfusion therapies.
Catheter-directed mechanical thrombectomy (CDMT) showed increasing trends in utilization and improving outcomes over the study period.
Concomitant acute popliteal or femoral deep vein thrombosis (DVT) in SPE-ACP patients was associated with lower in-hospital mortality risk.
The study used the National Inpatient Sample with statistical methods including propensity score matching to compare reperfusion strategies for SPE-ACP.
This research suggests that saddle pulmonary embolism with acute cor pulmonale (SPE-ACP) — a serious condition where a large blood clot straddles the main blood vessel of the lungs and causes the right side of the heart to strain — is becoming more commonly diagnosed in U.S. hospitals. Using a large national database covering 2016 to 2022, researchers found that this condition represented about 1.7% of all pulmonary embolism cases, with its frequency rising significantly over time. Nearly half of patients were treated with conventional therapy alone, while the rest received more aggressive clot-removal strategies. Among the advanced clot-removal treatments, systemic fibrinolysis (clot-dissolving drugs given through a vein) was linked to the worst outcomes, including higher rates of major bleeding and in-hospital death. Catheter-directed thrombolysis (delivering clot-dissolving drugs directly to the clot via a thin tube) showed the most favorable outcomes overall, including lower transfusion needs and better rates of patients going home rather than to other care facilities. A newer technique — catheter-directed mechanical thrombectomy, which physically removes the clot using a device — showed a trend of increasing use and improving outcomes over the study period, with results becoming comparable to catheter-directed thrombolysis in the most recent years (2020–2022). This research also found that patients who had an additional blood clot in their leg veins (femoral or popliteal deep vein thrombosis) alongside their saddle pulmonary embolism had a somewhat lower risk of dying in the hospital, a somewhat counterintuitive finding that may warrant further investigation. Overall, the study highlights that while this is a rare and serious condition, treatment approaches are evolving, and newer mechanical clot-removal techniques may be emerging as effective alternatives to drug-based catheter treatments.
Li W, Kakkos S, Tawakol A, Reed G, Henke P, Secemsky E, et al.. (2026). Saddle pulmonary embolism with acute cor pulmonale in contemporary practice: Epidemiological trends and reperfusion strategies.. Vascular medicine (London, England). https://doi.org/10.1177/1358863X261431264