Risk stratification of pulmonary embolism

Abstract

Purpose of review: Pulmonary embolism is the third most frequent type of cardiovascular disease behind coronary artery disease and stroke. Patients with acute pulmonary embolism have significant variability in short-term mortality from less than 0.6% in low-risk patients to 19% in high-risk patients. Risk stratification plays an important role in the management of acute pulmonary embolism as it can determine the need for urgent reperfusion therapies versus conservative strategies.

Recent findings: The three fundamental steps of risk stratification include the immediate identification of patients that are at high risk for mortality, the identification of patients that are at an increased risk of complications from pulmonary embolism that requires hospital monitoring and potential escalation of therapies, and the identification of patients at a low risk that can be treated as an outpatient.

Summary: It is vital to immediately identify high-risk patients for mortality so that they can be evaluated for urgent reperfusion therapies to improve outcomes. Risk stratification for intermediate-risk patients is based on right ventricular dysfunction in patients with hemodynamic stability. RV dysfunction can be assessed by clinical signs and symptoms along with ECHO and cardiac biomarkers. Identifying the low-risk population can help reduce the healthcare burden by allowing for early discharge and outpatient management.