Classification and Stratification of Pulmonary Embolisms

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.

Charlson and Elixhauser Comorbidity Indices for Prediction of Mortality and Hospital Readmission in Patients With Acute Pulmonary Embolism

“…Patients were stratified into subcategories according to the ACC/AHA (low risk, sub-massive, and massive) and ESC/ERS (low risk, intermediate-low risk, intermediate-high risk, and high risk) guidelines. 8 , 9 Provoked VTE was classified as the occurrence of VTE in association with major transient or minor transient or persistent risk factors; VTE was classified as unprovoked in the absence of any identifiable risk factors. Risk factors for provoked PE including recent surgery within 2 months before PE, immobilization lasting longer than 4 days in the 2-month period before PE, the use of estrogen or oral contraceptive therapy before PE, and pregnancy or postpartum state before PE were collected from patient charts.…”

“…Standard classifications of PE severity include the American Heart Association/American College of Cardiology (AHA/ACC) and the European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. 8 , 9 The most commonly used risk scores for predicting prognosis in PE are the Pulmonary Embolism Severity Index (PESI) and Simplified Pulmonary Embolism Severity Index (sPESI) scores. The PESI score uses 11 clinical and demographic pieces of information to stratify patients with acute PE into 5 classes that confer risk of 30-day mortality.…”

Role of Extracorporeal Membrane Oxygenation in the Treatment of Massive Pulmonary Embolism

“…A pump withdraws deoxygenated blood from a venous canula and pumps it through a heat exchanger, a membrane oxygenator, and finally, a femorally placed arterial cannula back to the aorta (►Fig. 1). Previously, femoral venous and arterial cannulae were inserted by cutdown technique.…”

Epidemiology, Etiology, and Pathophysiology of Pulmonary Embolism

“…9 However, it is pertinent to note that the burden of comorbidities associated with PE (such as malignancy, obesity, and advanced age) has also increased over the past 20 years. [12][13][14][15][16] The thromboembolic risk associated with malignancies is well documented. There has been a steady increase in survival in many cancers over the last two decades.…”

“…1 Accordingly, it is a leading cause of morbidity and mortality. 13 Time-trend analysis in North American, European, and Asian populations suggest that mortality rates associated with PE has been declining. 1,17 18 Age-standardized mortality rate decreased from 6.0 deaths per 100,000 population in 2000 to 4.4 deaths per 100,000 in 2006.…”