Latsios G, Mantzouranis E, Kachrimanidis I, Theofilis P, Dardas S, Stroumpouli E, Aggeli C, Tsioufis C. Recent advances in risk stratification and treatment of acute pulmonary embolism. World J Cardiol 2025; 17(5): 104983 [DOI: 10.4330/wjc.v17.i5.104983]
Corresponding Author of This Article
George Latsios, MD, PhD, Chief Physician, 1st Department of Cardiology, “Hippokration” General Hospital, Athens Medical School, Alexandroupoleos 9, Athens 11527, Greece. glatsios@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. May 26, 2025; 17(5): 104983 Published online May 26, 2025. doi: 10.4330/wjc.v17.i5.104983
Recent advances in risk stratification and treatment of acute pulmonary embolism
George Latsios, Emmanouil Mantzouranis, Ioannis Kachrimanidis, Panagiotis Theofilis, Sotirios Dardas, Evaggelia Stroumpouli, Constantina Aggeli, Costas Tsioufis
George Latsios, Emmanouil Mantzouranis, Ioannis Kachrimanidis, Panagiotis Theofilis, Sotirios Dardas, Constantina Aggeli, Costas Tsioufis, 1st Department of Cardiology, “Hippokration” General Hospital, Athens Medical School, Athens 11527, Greece
Evaggelia Stroumpouli, Department of Radiology, “Hippokration” General Hospital, Athens Medical School, Athens 11527, Greece
Author contributions: Latsios G and Mantzouranis E were involved in the graphical abstract; Latsios G contributed to the conceptualization of this manuscript; Latsios G, Mantzouranis E, Kachrimanidis I, Theofilis P, Dardas S, and Stroumpouli E participated in the writing and review; Latsios G, Aggeli C, and Tsioufis C contributed to the review and supervision of this manuscript. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: George Latsios, MD, PhD, Chief Physician, 1st Department of Cardiology, “Hippokration” General Hospital, Athens Medical School, Alexandroupoleos 9, Athens 11527, Greece. glatsios@gmail.com
Received: January 11, 2025 Revised: March 6, 2025 Accepted: April 8, 2025 Published online: May 26, 2025 Processing time: 132 Days and 20.8 Hours
Abstract
Pulmonary embolism (PE) represents the third leading cause of cardiovascular death, despite the implementation of European Society of Cardiology guidelines, the establishment of PE response teams and advances in diagnosis and treatment modalities. Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration. In this light, research has been focused to identify novel risk stratification tools, based on the hemodynamic impact of PE on right ventricular function. Furthermore, a growing body of evidence has demonstrated that novel interventional treatments for PE, including catheter directed thrombolysis, mechanical thrombectomy and computer-assisted aspiration, are promising solutions in terms of efficacy and safety, when targeted at specific populations of the intermediate-high- and high-risk spectrum. Various therapeutic protocols have been suggested worldwide, regarding the indications and proper timing for interventional strategies. A ST-elevation myocardial infarction-like timing approach has been suggested in high-risk PE with contraindications for fibrinolysis, while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate; however, early interventions, within 24-48 hours of presentation, are associated with more favorable outcomes.
Core Tip: Pulmonary embolism remains a major clinical challenge with unacceptably high mortality, especially in intermediate-high risk patients. Despite major advances in risk stratification, identifying stable patients at risk of decompensation remains unsolved. Emerging catheter-based therapies prove promising and safe, but proper patient selection and optimal timing require further investigation. A multidisciplinary approach is crucial for improving outcomes, while future research should focus on validating risk tools, standardizing protocols, and evaluating hard clinical endpoints in interventional trials.
