Table 1
American Heart Association classification of pulmonary embolism. BP: blood pressure; BPM: beats per minute; RV: right ventricular; BNP: brain natriuretic peptide; EKG: electrocardiogram; CT: computer tomography
| Massive pulmonary embolism | Sustained hypotension (systolic BP < 90 mm Hg for 15 min or requiring ionotropic support), or pulselessness, or sustained heart rate < 40 BPM with signs/symptoms of shock |
| Sub-massive pulmonary embolism | Systolic BP > 90 mm Hg and RV dysfunction or myocardial necrosis defined by: RV dilation (apical 4-chamber RV diameter divided by LV diameter > 0.9), or RV systolic dysfunction on echocardiography, or RV dilation (4-chamber RV diameter divided by LV diameter > 0.9) on CT, or elevation of BNP (> 90 pg/mL), or N-terminal pro-BNP (> 500 pg/mL), or EKG changes (new complete or incomplete right bundle-branch block, anteroseptal ST elevation or depression, or anteroseptal T-wave inversion), or elevation of troponin I (> 0.4 ng/mL) or troponin T (> 0.1 ng/mL) |
| Low-risk pulmonary embolism | Absence of adverse prognosis markers defining massive or submassive PE |
Table 2
European Society of Cardiology Classification of High-Risk Pulmonary Embolism. BP: blood pressure; CTPE: computed tomography pulmonary angiography; PESI: Pulmonary Embolism Severity Index; sPESI: simplified PESI; TTE: transthoracic echocardiogram; PE: pulmonary embolism; RV: right ventricular; CTPA: computed tomography pulmonary angiography
| High risk | Cardiac arrest, obstructive shock (systolic BP < 90 mm Hg despite an adequate filling status, in combination with end-organ hypoperfusion), or persistent hypotension (systolic BP drop > 40 mm Hg for > 15 min, not caused by new-onset arrhythmia, hypovolemia, or sepsis), or CTPA with hemodynamic instability and clinical PESI score of Class III-V or sPESI of > 1 |
| Intermediate high risk | Signs of RV dysfunction on TTE (or CTPA) with elevated cardiac biomarker levels |
| Intermediate low risk | Clinical parameters of PE severity and/ or comorbidity: PESI class III–V or sPESI ≥ 1 with the presence of either RV dysfunction on TTE or CTPA. Cardiac biomarkers may be normal or elevated |
| Low risk | No cardiac markers, no RV dysfunction, no hemodynamic instability |