Effect of Early Versus Late Catheter-Directed Intervention on Clinical Outcomes in Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis

Alaa Abdrabou Abouelmagd, Bahy Abofrekha, Bashar M. Al Zoubi, Ibrahim Gowaily, Mohamed Hassan Mady, Anas Hussein Heiba, AlMothana Manasrah, Mohamed Elshahat, Mustafa Turkmani, Mohamed Abuelazm 

https://doi.org/10.1002/pul2.70238 

Abstract

Catheter-directed intervention (CDI) in patients presenting with pulmonary embolism (PE) is suggested to improve in-hospital outcomes. We aimed to compare the effect of early versus late initiation of CDI on in-hospital outcomes. A systematic review and meta-analysis were conducted according to PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and Embase databases was performed from inception to May 2025. Data extraction was conducted independently by multiple reviewers. Statistical analysis was performed using R software version 4.3.2, and odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were combined using a random-effects model. Six studies, including 53,472 patients, were included. Early intervention before 24 h significantly reduced mortality (OR 0.61, 95% CI [0.44–0.84]; I² = 0%). Moreover, Early intervention before 24 h significantly reduced the all-cause readmission in patients with acute PE (OR = 0.81 (95% CI: [0.73, 0.89]; I² = 0%). There was no significant difference in risk of major bleeding in early vs late intervention (OR = 0.82; 95% CI: [0.48, 1.39]; I² = 69.3%). Also, early intervention before 24 h significantly reduced the length of hospital stay (LOS) (MD = –3.11 days (95% CI: [–4.33, –1.89]; I² = 0%). This meta-analysis showed that early CDI, particularly within 24 h of presentation, is associated with a significant reduction in both mortality and all-cause readmission in patients with acute PE, without increasing the risk of bleeding. These findings support the concept of “time-is-myocardium” and reinforce the need for structured protocols that enable early therapeutic intervention. Further randomized controlled trials are needed to confirm these findings and to establish the optimal timing for this potentially life-saving therapy.

Read the full research article