From the Guidelines
Pulmonary embolism (PE) can be classified into three main types: low-risk, submassive, and massive, based on the severity of the condition and the presence of hemodynamic instability or right ventricular dysfunction. The classification of PE into these categories is crucial for determining the appropriate treatment approach and predicting patient outcomes 1.
Types of Pulmonary Embolism
- Low-risk PE: characterized by the absence of hemodynamic instability and right ventricular dysfunction, accounting for 40% to 60% of hospitalized patients with PE, with an average mortality of ≈1% within 1 month 1.
- Submassive PE: characterized by right ventricular strain without hypotension, including RV dysfunction on computed tomography pulmonary angiography or echocardiography, or RV injury and pressure overload detected by an increase in cardiac biomarkers 1.
- Massive PE: characterized by hypotension, defined as a systolic blood pressure <90 mm Hg, a drop of >40 mm Hg for at least 15 minutes, or need for vasopressor support, accounting for ≈5% of hospitalized patients with PE, with an average mortality of ≈30% within 1 month 1.
Importance of Classification
The classification of PE into these categories is essential for guiding treatment decisions, as the benefits and risks of different treatment approaches vary depending on the severity of the condition 1. For example, patients with low-risk PE may be treated with anticoagulation alone, while those with submassive or massive PE may require more aggressive treatment, such as thrombolytic therapy or mechanical embolectomy.
Clinical Implications
Understanding the different types of PE and their classification is critical for clinicians to provide optimal care for patients with this condition, as it allows for tailored treatment approaches and improved patient outcomes 1.
From the Research
Types of Pulmonary Embolism (PE)
Pulmonary embolism (PE) can be categorized based on several factors, including:
- Hemodynamic status: PE can be classified as hemodynamically stable or unstable, with unstable PE being a life-threatening condition 2, 3
- Temporal patterns: PE can be acute or chronic, with acute PE being a sudden onset and chronic PE being a long-standing condition 4, 5
- Anatomic locations of emboli: PE can be classified based on the location of the embolus in the pulmonary arteries, with central PE being more severe than peripheral PE 6, 5
- Risk categories: PE can be stratified into different risk categories, including low-risk, intermediate-risk, and high-risk, based on clinical parameters, laboratory findings, and imaging markers 2, 6, 3
Risk Stratification
Risk stratification is crucial in determining the severity of PE and guiding treatment decisions. Various tools and parameters are available for risk stratification, including:
- Wells score 2
- Pulmonary Embolism Severity Index 2
- Hestia criteria 2
- Clinical scoring systems 4
- Laboratory data and imaging studies 4, 5
Clinical Presentation
The clinical presentation of PE can vary widely, ranging from asymptomatic to life-threatening events. Common symptoms include: