Progress Toward Prognosis in Patients With Pulmonary Embolism

Venous thromboembolism, affecting >1 million individuals in the United States annually, remains a major global health and mortality burden. 1 Tsao C.W. Aday A.W. Almarzooq Z.I. et al. Heart disease and stroke statistics—2023 update: a report from the American heart association. Circulation. 2023; 147: e93-e621 Google Scholar Despite significant advancements in diagnosis and treatment, the 30-day mortality rate overall for acute pulmonary embolism (PE) is approximately 4% to 6%. 2 Jiménez D. de Miguel-Diéz J. Guijarro R. et al. Trends in the management and outcomes of acute pulmonary embolism: analysis from the RIETE registry. J Am Coll Cardiol. 2016; 67: 162-170 Google Scholar The cornerstone of acute PE management is rapid diagnosis and accurate stratification of risk for adverse outcomes. 3 Osho A.A. Dudzinski D.M. Interventional therapies for acute pulmonary embolism. Surg Clin N Am. 2022; 102: 429-447 Google Scholar However, treatment decisions are often challenging because of the diverse range of severity and risk profiles in acute PE, each with variable potential for clinical deterioration. Current guidelines 4 Konstantinides S.V. Meyer G. Becattini C. et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur. Heart J. 2020; 41: 543-603 Google Scholar recommend categorizing PE severity into high-risk, intermediate-risk (with intermediate-high and intermediate-low subtypes), and low-risk groups, taking into consideration hemodynamic stability, right ventricular (RV) dysfunction, and cardiac biomarkers. Patients with PE at high risk are readily recognized by manifestations of shock with hemodynamic instability, end-organ hypoperfusion, or cardiac arrest, necessitating swift implementation of reperfusion therapy options such as intravenous systemic thrombolysis, surgical thrombectomy, or catheter-directed therapy, potentially coupled with temporary mechanical circulatory support. 3 Osho A.A. Dudzinski D.M. Interventional therapies for acute pulmonary embolism. Surg Clin N Am. 2022; 102: 429-447 Google Scholar Conversely, low-risk patients demonstrate hemodynamic stability, absence of RV dysfunction, and normal cardiac biomarkers; such patients can often be managed with direct oral anticoagulants and may be considered for outpatient care. 4 Konstantinides S.V. Meyer G. Becattini C. et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur. Heart J. 2020; 41: 543-603 Google Scholar