Have we found how to identify candidates for thrombolysis among normotensive patients with acute pulmonary embolism?

Acute pulmonary embolism (PE) results in a wide spectrum of haemodynamic compromise and in hospital PE-related mortality. It is generally accepted that haemodynamically unstable patients with systolic blood pressure <90 mmHg at presentation form a high-risk group (∼5% of all PE patients), with short-term mortality exceeding 15%. They require urgent primary revascularisation performed mostly with systemic thrombolysis. In contrast, only a few patients without shock or hypotension are at risk of an adverse early outcome [1]. Thus, clinically stable, non-high risk patients require further risk stratification in order to optimise their management, including selection of the therapeutic strategy and the duration of the hospitalisation. Current European Society of Cardiology (ESC) guidelines introduced the simplified Pulmonary Embolism Severity Index (sPESI) [2], used for identification of the low-risk group [1]. Patients with sPESI of 0 are at the “benign” end of the risk spectrum; mostly, they have uncomplicated clinical courses and are candidates for very short hospitalisation or can even be managed as outpatients without any further risk stratification.