SEX DIFFERENCES IN CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS UNDERGOING CATHETER–DIRECTED TREATMENTS FOR HIGH RISK AND INTERMEDIATE–HIGH RISK ACUTE PULMONARY EMBOLISM. DO WE NEED SEX–SPECIFIC CONSIDERATIONS IN THE MANAGEMENT OF ACUTE PE?
Bibliographic record
Abstract
Abstract Background Acute pulmonary embolism (PE) is a common disease associated with a high mortality rate. Catheter–Directed Treatments (CDTs) could address some unsolved issues in high and intermediate–high risk PE patients evolving towards hemodynamic deterioration when systemic thrombolysis (ST) is contraindicated or fails. Few data in literature suggest that female patients hospitalized for PE experience adverse clinical outcomes as compared with their male counterparts. However, whether there is a specific impact of sex on CDTs outcomes in PE within real–world clinical settings remains unexplored. Methods This is a multicenter retrospective study including patients admitted in five Italian Centers, who underwent CDTs for high and intermediate–high risk PE, as defined by ESC Guidelines. In–hospital and one–year clinical outcomes were evaluated using medical records and follow–up assessments. Bleeding events were defined according to the Bleeding Academic Research Consortium (BARC) criteria. Results A total of 191 patients were included, 101 women (52.9%) and 90 men (47.1%). High risk PE was diagnosed in 56 (29%) patients, while intermediate–high risk PE was diagnosed in 135 (71%). Of these, 132 (69%) were treated by ultrasound–assisted thrombolysis (USAT), with negligible sex disparity between treatment modalities. Notably, female patients presented more frequently with cardiac arrest (11% vs. 2.6%, p = 0.03), had lower prevalence of absolute contraindications to ST (23% vs. 42%, p = 0.004) and history of recent major surgery (8.9% vs. 22%, p = 0.01). Female patients had a trend towards higher procedural–related complications (17% versus 9%, OR 2.07 95%CI 0.87–5.33, p=0.11), higher in–hospital mortality rate (20% versus 8.9%, OR 2.53 95%C.I. 1.09–6.41, p=0.038) and higher likelihood of bleeding events (22% versus 10%, OR 2.54 95%CI 1.13–6.14, p=0.029). At 1 year follow–up, female sex was associated with higher all–cause mortality (29.1% versus 12.7%, HR 2.50 95%CI 1.15–5.43, p=0.022). Multivariate regression analysis identified female sex, diagnosis of high–risk PE and a history of neoplasia as independent predictors of 1–year all–cause mortality. Conclusions In our experience, female patients undergoing CDTs for acute PE showed worse clinical presentation, higher procedural–related complications, and poorer outcomes than males. In our opinion this sex disparity underscores the need for sex–specific considerations in acute PE management strategies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".