- Design
- Retrospective two-campus cohort
- Population
- 2,251 hospitalised patients with acute pulmonary embolism
- Primary outcome
- 30-day all-cause mortality
- Effect
- AUC 0.885 (AHA/ACC) vs 0.763 (ESC); difference 0.122 (0.084–0.160)
A retrospective cohort in Chest (29 September) applied both the 2026 AHA/ACC acute pulmonary embolism clinical categories and the 2019 ESC risk classes to 2,251 inpatients with acute PE at a Chinese tertiary hospital between 2013 and 2025. Thirty-day mortality was 5.6%.
The AHA/ACC scheme discriminated 30-day mortality better (area under the curve 0.89 vs 0.76) and PE-related death better (0.94 vs 0.83). At comparable specificity, it identified 84% of PE-related deaths in its top categories against 59% for ESC high risk. Thirty-seven patients placed in AHA/ACC categories D–E but ESC intermediate risk had striking mortality: 76% died within 30 days.
Much of the advantage came from the extremes of the spectrum and narrowed in the middle range. But the discordant group is the practical point: some patients not haemodynamically unstable by ESC criteria are already failing and need escalation-level attention.
- The AHA/ACC categories separated 30-day mortality better than ESC classes
- Patients in AHA/ACC categories D–E but ESC intermediate risk had very high mortality
- Look beyond blood pressure for signs of evolving failure: lactate, oxygen need, RV strain
- Retrospective, single-institution data — validate locally before changing pathways
Why it matters
Some patients classed as intermediate risk are already deteriorating and may need escalation.
Don't overread it
Retrospective and from one centre — it compares prediction, not whether using either scheme changes outcomes.
The statistics, in plain English
An AUC of 0.89 means the scheme ranks a patient who dies above one who survives 89% of the time. The difference narrowed to 0.11 once the extreme categories were removed, so much of the gain is at the ends of the spectrum.
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