ECG Abnormalities and Biomarkers Enable Rapid Risk Stratification in Normotensive Patients With Acute Pulmonary Embolism

PMCID: PMC12178209

PMID: 40536791

DOI: 10.1111/crj.70060

Journal: The clinical respiratory journal

Publication Date: 2025-6-19

Authors: Jiao S, Liu Y, He H, Li Q, Wang Z, et al.

Key Points

• Low QRS voltage on ECG was the strongest independent predictor of in-hospital adverse events (OR: 5.321)
• The novel risk model achieved 76.0% sensitivity and 86.9% specificity for predicting adverse events
• Rapid risk assessment using initial ECG and biomarkers can help identify PE patients at higher risk of clinical deterioration

Summary

This single-center retrospective study investigated risk factors for in-hospital adverse events among normotensive pulmonary embolism (PE) patients. The researchers developed a novel predictive model using readily available clinical parameters, finding that 16.4% of patients experienced adverse events, including a 7.0% mortality rate. The model identified four key independent risk factors: low QRS voltage on ECG, positive age-adjusted D-dimer, positive troponin, and PaO2/FiO2 < 300.

The proposed risk model demonstrated superior predictive performance compared to existing risk stratification scores (PESI, sPESI, Bova, and FAST), with a significantly higher area under the ROC curve (0.847 vs. 0.628-0.775). This approach offers clinicians a simple, non-invasive, and rapid method to assess risk in acute PE patients, potentially enabling more targeted interventions and closer monitoring for high-risk individuals.