ORCID
0000-0003-1366-3906 (Dexter)
Document Type
Article
Publication Date
2025
DOI
10.1161/CIRCULATIONAHA.124.072364
Publication Title
Circulation
Volume
151
Issue
5
Pages
260-273
Abstract
BACKGROUND: There are a lack of randomized controlled trial data comparing outcomes of different catheter-based interventions for intermediate-risk pulmonary embolism.
METHODS: PEERLESS is a prospective, multicenter, randomized controlled trial that enrolled 550 patients with intermediate-risk pulmonary embolism with right ventricular dilatation and additional clinical risk factors randomized 1:1 to treatment with large-bore mechanical thrombectomy (LBMT) or catheter-directed thrombolysis (CDT). The primary end point was a hierarchal win ratio composite of the following (assessed at the sooner of hospital discharge or 7 days after the procedure): (1) all-cause mortality, (2) intracranial hemorrhage, (3) major bleeding, (4) clinical deterioration and/or escalation to bailout, and (5) postprocedural intensive care unit admission and length of stay. Assessments at the 24-hour visit included respiratory rate, modified Medical Research Council dyspnea score, New York Heart Association classification, right ventricle/left ventricle ratio reduction, and right ventricular function. End points through 30 days included total hospital stay, all-cause readmission, and all-cause mortality.
RESULTS: The primary end point occurred significantly less frequently with LBMT compared with CDT (win ratio, 5.01 [95% CI, 3.68–6.97]; P24 hours (19.3% versus 64.5%). There were no significant differences in mortality, intracranial hemorrhage, or major bleeding between strategies or in a secondary win ratio end point including the first 4 components (win ratio, 1.34 [95% CI, 0.78–2.35]; P=0.30). At the 24-hour visit, respiratory rate was lower for patients treated with LBMT (18.3±3.3 versus 20.1±5.1; P
CONCLUSIONS: PEERLESS met its primary end point in favor of LBMT compared with CDT in treatment of intermediate-risk pulmonary embolism. LBMT had lower rates of clinical deterioration and/or bailout and postprocedural intensive care unit use compared with CDT, with no difference in mortality or bleeding.
Rights
© 2024 The Authors.
This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivatives (CC BY-NC-ND 4.0) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
Data Availability
Article states: "Data collected in this study will not be made available to others."
Original Publication Citation
Jaber, W. A., Gonsalves, C. F., Stortecky, S., Horr, S., Pappas, O., Gandhi, R. T., Pereira, K., Giri, J., Khandhar, S. J., Ammar, K. A., Lasorda, D. M., Stegman, B., Busch, L., Dexter, D. J., Azene, E. M., Daga, N., Elmasri, F., Kunavarapu, C. R., Rea, M. E.,…Gibson, C. M. (2025). Large-bore mechanical thrombectomy versus catheter-directed thrombolysis in the management of intermediate-risk pulmonary embolism: Primary results of the PEERLESS randomized controlled trial. Circulation, 151(5), 260-273. https://doi.org/10.1161/CIRCULATIONAHA.124.072364
Repository Citation
Jaber, W. A., Gonsalves, C. F., Stortecky, S., Horr, S., Pappas, O., Gandhi, R. T., Pereira, K., Giri, J., Khandhar, S. J., Ammar, K. A., Lasorda, D. M., Stegman, B., Busch, L., Dexter, D. J., Azene, E. M., Daga, N., Elmasri, F., Kunavarapu, C. R., Rea, M. E.,…Gibson, C. M. (2025). Large-bore mechanical thrombectomy versus catheter-directed thrombolysis in the management of intermediate-risk pulmonary embolism: Primary results of the PEERLESS randomized controlled trial. Circulation, 151(5), 260-273. https://doi.org/10.1161/CIRCULATIONAHA.124.072364
Supplemental Material
circ-2024-072364-s01.pdf (463 kB)
Supplemental Material - PEERLESS trial site principal investigators...