Risk Stratification of Pulmonary Embolism

Acute pulmonary embolism (PE) is a heterogenous condition, with varying early and long term clinical outcomes. The mortality rate in PE patients is higher than in patients with acute myocardial infarction, exceeding 10% at 30 days and 16% at 3 months [1]. Within 30 days, the most common cause of death is right ventricular failure, and most deaths beyond 30 days often are due to underlying chronic conditions, including cancer, congestive heart failure, or chronic lung disease. With therapeutic levels of anticoagulation, most patients will likely have an uneventful clinical course. Some patients, however, suffer rapid clinical deterioration, including death from right ventricular failure or the need for cardiopulmonary resuscitation, mechanical ventilation, administration of pressors for systolic arterial hypotension, rescue thrombolysis, or surgical embolectomy. Contemporary PE risk stratification tools are (1.) the clinical evaluation, (2.) cardiac biomarkers, (3.) twelve-lead electrocardiography, (4.) echocardiography, and (5.) chest computed tomography.