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Risk Stratification of Acute Pulmonary Embolism

  • Vascular Disease (V Lakhter, Section Editor)
  • Published:
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Abstract

Purpose of review

Acute pulmonary embolism (PE) is a heterogeneous disease process whose presentation varies widely between individuals who are asymptomatic, develop cardiogenic shock, or experience acute PE-related mortality. The purpose of this review is to summarize the available tools used to risk stratify patients presenting with acute PE. We will particularly focus on the demographic, clinical, laboratory, imaging, and multifactor tools used to predict mortality, PE-related morbidity, and bleeding complications.

Recent findings

Established risk assessment strategies incorporate clinical and demographic information into risk scores such as PESI, sPESI, HESTIA, or BOVA scores to stratify patients using their individual risk profiles. Elevated biomarkers (troponin, BNP/NT-Pro-BNP, lactate), evidence of RV dilation and dysfunction, decreased cardiac reserve, and residual lower extremity and intracardiac clot burden are associated with worse prognosis. Novel techniques to identify cardiac reserve are helpful to identify patients who are at high risk for early decompensation.

Summary

Early standardized risk stratification plays a crucial role in management of patients with acute PE. Identification of low-risk population allows for early discharge and outpatient management, while identification of high-risk population allows for rapid escalation of care and allocation of highly specialized resources in a timely fashion. Finally, pulmonary embolism response team model of care has allowed standardization of management of acute PE by harnessing expertise from multiple subspecialties.

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Authors and Affiliations

  1. Division of Cardiology, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University Hospital, 833 Chestnut Street, Suite 640, Philadelphia, PA, 19107, USA

    Yevgeniy Brailovsky DO MSc

  2. Division of Cardiology, Loyola University Medical Center, Maywood, IL, USA

    Sorcha Allen MD & Amir Darki MD MSc

  3. Department of Pharmacology, Loyola University Medical Center, Maywood, IL, USA

    Dalila Masic PharmD

  4. Hunter College, City University of New York, New York, NY, USA

    David Lakhter

  5. Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA

    Sanjum S. Sethi MD, MPH

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  1. Yevgeniy Brailovsky DO MSc
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Yevgeniy Brailovsky, Sorcha Allen, Dalila Masic, David Lakhter, and Amir Darki declare no competing interests.

Sanjum S. Sethi reports personal fees from Janssen and personal fees from Chiesi, outside the submitted work.

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Brailovsky, Y., Allen, S., Masic, D. et al. Risk Stratification of Acute Pulmonary Embolism. Curr Treat Options Cardio Med 23, 48 (2021). https://doi.org/10.1007/s11936-021-00923-4

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