Prognostic staging of acute pulmonary embolism: are we closer to the holy grail?

Management strategy and its influence on the outcomes for patients with acute pulmonary embolism (PE) has been an area of chronic debate and unresolved controversies. During the last decade at least 50 publications have provided important evidence on prognostic markers, with the hope of improving risk stratification and, consequently, treatment decisions for PE. Such markers ranged from simple clinical signs to variables, which require sophisticated laboratory tests and modern cardiovascular imaging. Paradoxically, messages most relevant to a practicing clinician confronting a patient with acute PE, so far, seem to emerge from clinical evaluation. Signs of shock or significant hypotension became universally accepted markers of high risk PE, justifying emergency thrombolysis [1]. More recently, several clinical scores have been reliably validated to identify patients at a very low risk of adverse outcomes, despite confirmed PE [2–4]. If adequately anticoagulated, such patients may be offered an option of early discharge and ambulatory therapy [5].