- Design
- Retrospective two-campus cohort
- Population
- 2251 hospitalised patients with acute PE, China, 2013-2025
- Primary outcome
- 30-day all-cause mortality discrimination
- Effect
- AUC 0.885 (AHA/ACC) vs 0.763 (ESC); difference 0.122 (95% CI 0.084-0.160)
This retrospective study at a two-campus Chinese tertiary hospital compared the 2026 AHA/ACC acute pulmonary embolism (PE) clinical categories with the 2019 ESC risk classification in 2251 hospitalised patients. Published in Chest on 29 September 2026.
Thirty-day mortality was 5.6%. The AHA/ACC categories discriminated better (AUC 0.885 vs 0.763 for all-cause death; 0.942 vs 0.826 for PE-related death). Using AHA/ACC categories D-E as high risk caught 84% of PE-related deaths, against 59% for the ESC high-risk stratum, with similar specificity. Of 37 patients in AHA/ACC D-E but ESC intermediate risk, 76% died within 30 days.
The ESC scheme reserves high risk for haemodynamic instability. The newer US categories grade severity more finely, including impending cardiopulmonary failure, which seems to capture patients deteriorating before overt shock.
The advantage shrank when the extreme categories were removed, and this is a single-centre retrospective study. It is a reason to look closely at intermediate-risk patients with features of impending collapse, not yet to change escalation pathways.
- Look beyond blood pressure for signs of impending collapse in intermediate-risk PE
- Check lactate, oxygen requirement, RV function and troponin together
- Consider early escalation discussion for intermediate-risk patients who are worsening
- Monitor intermediate-high-risk patients in a high-dependency setting where possible
Why it matters
A normal blood pressure can hide a patient with PE who is close to collapse.
Don't overread it
Single-centre and retrospective; it compares prognosis, not whether acting on the categories changes outcomes.
The statistics, in plain English
An AUC measures how well a score ranks who dies above who survives; 0.885 versus 0.763 is a meaningful gap. The gap narrowed in the middle range of severity, which is where the hardest decisions are made.
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