Int J Angiol 2022; 31(03): 162-165
DOI: 10.1055/s-0042-1756218
Invited Article

Classification and Stratification of Pulmonary Embolisms

1   The American University of the Caribbean School of Medicine, Pembroke Pines, Florida
,
2   Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
3   Division of Cardiothoracic Surgery, Kentucky Clinic, University of Kentucky College of Medicine, Lexington, Kentucky
,
Sibu Saha
2   Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
3   Division of Cardiothoracic Surgery, Kentucky Clinic, University of Kentucky College of Medicine, Lexington, Kentucky
› Author Affiliations
Funding None declared.

Abstract

Pulmonary embolism remains a leading cause of cardiovascular mortality. Presentation and outcomes are variable among patients and require rapid risk stratification for assessment and prognosis, as well as selection of appropriate treatment. Over the past several decades, several different models and parameters have become available to assess risk and classify pulmonary embolism into different risk categories. Some patients may be candidates for early discharge or complete outpatient treatment, while some may require invasive diagnostics and intensive monitoring. In this review, we summarize contemporary guidelines and methods for classification and risk stratification in an effort to provide tools for physicians to use in their management of patients with acute pulmonary embolisms.

Authors' Contribution

Sibu Saha contributed to the conception and design of the review. Suresh Keshavamurthy and Cody Russell contributed to the acquisition, analysis, and interpretation of the data. Cody Russell drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript




Publication History

Article published online:
02 September 2022

© 2022. International College of Angiology. This article is published by Thieme.

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  • References

  • 1 Centers for Disease Control and Prevention (CDC). Venous thromboembolism in adult hospitalizations - United States, 2007-2009. MMWR Morb Mortal Wkly Rep 2012; 61 (22) 401-404
  • 2 Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med 2010; 38 (4, Suppl): S495-S501
  • 3 Giri J, Sista AK, Weinberg I. et al. 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 (20) e774-e801
  • 4 Jiménez D, Aujesky D, Yusen RD. Risk stratification of normotensive patients with acute symptomatic pulmonary embolism. Br J Haematol 2010; 151 (05) 415-424
  • 5 Yu S, Zhou H, Li Y. et al. PERFORM: Pulmonary embolism risk score for mortality in computed tomographic pulmonary angiography-confirmed patients. EClinicalMedicine 2021; 36: 100897 DOI: 10.1016/j.eclinm.2021.100897.
  • 6 Konstantinides SV, Meyer G, Becattini C. et al; ESC Scientific Document Group. 2019 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 (04) 543-603
  • 7 Sista AK, Kuo WT, Schiebler M, Madoff DC. Stratification, imaging, and management of acute massive and submassive pulmonary embolism. Radiology 2017; 284 (01) 5-24
  • 8 Higazi MM, Fattah RARA, Abdelghany EA, Ghany HSA. Efficacy of computed tomography pulmonary angiography as non-invasive imaging biomarker for risk stratification of acute pulmonary embolism. J Clin Imaging Sci 2020; 10: 49 DOI: 10.25259/jcis_75_2020.
  • 9 Moores L, Zamarro C, Gómez V. et al; Instituto Ramón y Cajal de Investigación Sanitaria Pulmonary Embolism Study Group. Changes in PESI scores predict mortality in intermediate-risk patients with acute pulmonary embolism. Eur Respir J 2013; 41 (02) 354-359
  • 10 Abrahams-van Doorn PJ, Hartmann IJ. Cardiothoracic CT: one-stop-shop procedure? Impact on the management of acute pulmonary embolism. Insights Imaging 2011; 2 (06) 705-715
  • 11 Jeebun V, Doe SJ, Singh L, Worthy SA, Forrest IA. Are clinical parameters and biomarkers predictive of severity of acute pulmonary emboli on CTPA?. QJM 2010; 103 (02) 91-97
  • 12 Praveen Kumar BS, Rajasekhar D, Vanajakshamma V. Study of clinical, radiological and echocardiographic features and correlation of Qanadli CT index with RV dysfunction and outcomes in pulmonary embolism. Indian Heart J 2014; 66 (06) 629-634
  • 13 Mastora I, Remy-Jardin M, Masson P. et al. Severity of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echocardiographic data. Eur Radiol 2003; 13 (01) 29-35
  • 14 Qanadli SD, El Hajjam M, Vieillard-Baron A. et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol 2001; 176 (06) 1415-1420
  • 15 Triantafyllou GA, O'Corragain O, Rivera-Lebron B, Rali P. Risk stratification in acute pulmonary embolism: the latest algorithms. Semin Respir Crit Care Med 2021; 42 (02) 183-198
  • 16 Bova C, Sanchez O, Prandoni P. et al. Identification of intermediate-risk patients with acute symptomatic pulmonary embolism. Eur Respir J 2014; 44 (03) 694-703
  • 17 Fernández C, Bova C, Sanchez O. et al. Validation of a model for identification of patients at intermediate to high risk for complications associated with acute symptomatic pulmonary embolism. Chest 2015; 148 (01) 211-218
  • 18 Keller K, Beule J, Balzer JO, Dippold W. Modified Bova score for risk stratification and short-term outcome in acute pulmonary embolism. Neth J Med 2015; 73 (09) 410-416
  • 19 Jiménez D, Kopecna D, Tapson V. et al; On Behalf Of The Protect Investigators. Derivation and validation of multimarker prognostication for normotensive patients with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med 2014; 189 (06) 718-726
  • 20 Roy PM, Penaloza A, Hugli O. et al; HOME-PE Study Group. Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial. Eur Heart J 2021; 42 (33) 3146-3157
  • 21 Weeda ER, Kohn CG, Peacock WF. et al. External validation of the Hestia criteria for identifying acute pulmonary embolism patients at low risk of early mortality. Clin Appl Thromb Hemost 2017; 23 (07) 769-774
  • 22 Zondag W, Vingerhoets LM, Durian MF. et al; Hestia Study Investigators. Hestia criteria can safely select patients with pulmonary embolism for outpatient treatment irrespective of right ventricular function. J Thromb Haemost 2013; 11 (04) 686-692
  • 23 Porres-Aguilar M, Anaya-Ayala JE, Jiménez D, Mukherjee D. Pulmonary embolism response teams: pursuing excellence in the care for venous thromboembolism. Arch Med Res 2019; 50 (05) 257-258
  • 24 Rosovsky R, Chang Y, Rosenfield K. et al. Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis. J Thromb Thrombolysis 2019; 47 (01) 31-40