Gender Differences in Management and Outcomes of High-Risk Pulmonary Embolism: A Nationwide Analysis

Background: Gender disparities in the clinical presentation, management, and outcomes of high-risk pulmonary embolism (PE) are underexplored, particularly in light of emerging percutaneous treatment options. These minimally invasive therapies have transformed PE care, yet data on gender-specific differences in their utilization and associated outcomes remain scarce. Understanding these disparities is critical to inform equitable and effective clinical strategies.

Methods: We analyzed data from patients hospitalized with high-risk PE, comparing males (n=21,965) and females (n=23,275). Baseline characteristics, management strategies, and outcomes were evaluated. Multivariate logistic regression assessed adjusted odds ratios (aOR) for key outcomes and procedures among females, using males as the reference group.

Results: Females were older (mean 65.2 vs. 63.4 years, p<0.001) and more likely to have obesity (28.5% vs. 21.9%, p<0.001) or anemia (44.4% vs. 38.2%, p<0.001). Systemic thrombolysis was more common in females (17.5% vs. 15.5%, p<0.001), but catheter-directed embolectomy and surgical thrombectomy were less frequent (aOR 0.92, p=0.034; aOR 0.83, p=0.002). Females had higher in-hospital mortality (45.5% vs. 42.1%, p<0.001) and major adverse cardiovascular and cerebrovascular events (MACCE, 49.6% vs. 45.8%, p<0.001). Adjusted analysis confirmed higher odds of mortality (aOR 1.21, 95% CI 1.16–1.25) and MACCE (aOR 1.22, 95% CI 1.18–1.27) among females.

Conclusion: This study reveals significant gender disparities in the management and outcomes of high-risk PE, underscoring a pressing need for targeted interventions. While females are more likely to receive systemic thrombolysis, they undergo fewer invasive procedures and experience worse outcomes. These findings highlight the importance of integrating gender-sensitive approaches into the evolving landscape of percutaneous PE therapies, paving the way for improved care and outcomes for all patients.