Risk stratification in patients with acute pulmonary embolism (PE) is essential to
guide the choice of appropriate therapy. The stratification of risk is first and foremost
based on the presence of signs of hemodynamic instability, which is associated with
a very high risk of early death, but affects only around 5% of PE patients. For the
vast majority of normotensive PE patients, it is recommended to proceed with imaging,
mainly to investigate the presence of right ventricular (RV) dysfunction, and laboratory
indicators of PE severity (mostly deriving from the presence of RV dysfunction). In
addition, the presence of comorbidities should be investigated, or any other aggravating
condition that could negatively affect early prognosis. Clinical, imaging and biology
results are all directly related to the severity of PE and to the risk of early PE-related
death, whereas information about comorbidities and aggravating conditions are necessary
to assess the patient's overall risk of death.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Identification of intermediate-risk patients with acute symptomatic pulmonary embolism.Eur Respir J. 2014; 44: 694-703
- Comparison of risk assessment strategies for not-high-risk pulmonary embolism.Eur Respir J. 2016; 47: 1170-1178
- Fibrinolysis for patients with intermediate-risk pulmonary embolism.N Engl J Med. 2014; 370: 1402-1411
- Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER).Lancet. 1999; 353: 1386-1389
- Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model.Eur Respir J. 2016; 48: 780-786
- Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry.J Am Coll Cardiol. 1997; 30: 1165-1171
- Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis.JAMA. 2014; 311: 2414-2421
- Contemporary Management and Outcomes of Patients with Massive and Submassive Pulmonary Embolism.Am J Med. 2018; 131 (1506-1514): e0
- Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism.Circulation. 2003; 108: 2191-2194
- The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis.Crit Care. 2011; 15: R103
- ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).Eur Heart J. 2020; 41: 543-603
- Management of cardiogenic shock.Eur Heart J. 2015; 36: 1223-1230
- Short-term clinical outcome of normotensive patients with acute PE and high plasma lactate.Thorax. 2015; 70: 333-338
- Comparison of clinical scores for identification of patients with pulmonary embolism at intermediate-high risk of adverse clinical outcome: the prognostic role of plasma lactate.Intern Emerg Med. 2017; 12: 657-665
- Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism.Eur J Intern Med. 2021; https://doi.org/10.1016/j.ejim.2021.01.021
- Predictive value of the high-sensitivity troponin T assay and the simplified Pulmonary Embolism Severity Index in hemodynamically stable patients with acute pulmonary embolism: a prospective validation study.Circulation. 2011; 124: 2716-2724
- Prognostic value of troponins in acute pulmonary embolism: a meta-analysis.Circulation. 2007; 116: 427-433
- Predictors of mortality from pulmonary embolism and their influence on clinical management.Thromb Haemost. 2008; 100: 747-751
- Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association.Circulation. 2019; 140: e774-e801
Article info
Publication history
Published online: March 18, 2021
Accepted:
March 4,
2021
Received in revised form:
March 2,
2021
Received:
February 23,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
