Pulmonary vascular disease & thromboembolismRandomised controlled trial
Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis in the Management of Intermediate-Risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial
- Randomised controlled trial
- prospective
- multicentre
- 1:1 randomisation
Authors' conclusion
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.
Study context
- Population
- Intermediate-risk PE with RV dilatation and additional clinical risk factors
- Participants
- 550 participants
- Comparison
- Large-bore mechanical thrombectomy vs catheter-directed thrombolysis
- Primary endpoint
- Hierarchical win ratio composite:
- All-cause mortality
- Intracranial hemorrhage
- Major bleeding
- Clinical deterioration and/or escalation to bailout
- Postprocedural ICU admission
- Length of stay
- Follow-up
- Sooner of hospital discharge or 7 days after the procedure
Primary result
As reported in the abstract
Win ratio
5.01
95% CI 3.68–6.97
P < 0.001
Further findings
Clinical deterioration and/or bailout (primary composite component) · sooner of discharge or 7 days
P = 0.04
Postprocedural ICU use (primary composite component) · sooner of discharge or 7 days · less postprocedural ICU use
P < 0.001
ICU admission
ICU stay >24 hours
Secondary win ratio (first 4 components: mortality, intracranial hemorrhage, major bleeding, clinical deterioration/bailout)
- No significant difference in secondary win ratio end point; win ratio 1.34 (95% CI 0.78-2.35)
- P = 0.30
Respiratory rate · 24-hour visit
- Respiratory rate lower with large-bore mechanical thrombectomy (LBMT): 18.3±3.3 vs 20.1±5.1
- P < 0.001
Moderate to severe mMRC dyspnea score, NYHA classification and RV dysfunction · 24-hour visit
- Fewer with moderate to severe mMRC dyspnea scores with LBMT: 13.5% vs 26.4%
- P < 0.001
- Fewer with moderate to severe NYHA classifications with LBMT: 16.3% vs 27.4%
- P = 0.002
- Fewer with RV dysfunction with LBMT: 42.1% vs 57.9%
- P = 0.004
RV/LV ratio reduction · 24-hour visit
- RV/LV ratio reduction similar: 0.32±0.24 vs 0.30±0.26
- P = 0.55
Total hospital stay and all-cause readmission · 30 days
- Shorter total hospital stay with LBMT: 4.5±2.8 vs 5.3±3.9 overnights
- P = 0.002
- Fewer all-cause readmissions with LBMT: 3.2% vs 7.9%
- P = 0.03
All-cause mortality · 30 days
- 30-day mortality similar: 0.4% vs 0.8%
- P = 0.62
Original publication
Summarised from the published abstract; every number is checked against it