LAUSR

Quickly identify patients presenting with severe PE but also patients with intermediate‐high‐risk PE Severe or high-risk PE is defined by cardiac arrest, or persistent hypotension (i.e., systolic blood pressure < 90 mmHg or a systolic pressure drop by 40 mmHg, for > 15 min, if not caused by new onset arrhythmia, hypovolemia, or sepsis) accompanied by signs of end-organ hypoperfusion [1–3]. High-risk PE represents less than 5% of all acute PE and constitutes a medical emergency, associated with a 15–50% risk of in-hospital death, particularly during the first hours after admission [1–3]. Among initially hemodynamically stable patients, about 10% may suffer early clinical and hemodynamic deterioration, with an overall in-hospital mortality risk close to 50% [3, 4]. Risk stratification of acute PE patients allows physicians to identify such patients with an elevated risk of death or major complications [4]. Advanced risk stratification with the combination of clinical variables (i.e., tachycardia, mild hypotension, hypoxemia, age, and previous cardiorespiratory disease) using the PE severity index (PESI) or its simplified version (sPESI) [4], biomarkers reflecting myocardial dysfunction or injury, and imaging of right ventricular (RV) dysfunction allows one to identify the clinically stable patients with the highest risk of subsequent deterioration (intermediate-high-risk patients) who might benefit from intensive monitoring and even recanalization procedures (Supplementary Fig. 1) [1–4].