Acute Pulmonary Embolism: Current Concepts in Risk Stratification and Management

Abstract

Pulmonary embolism (PE) is a potentially life-threatening manifestation of venous thromboembolism and the third-leading cause of cardiovascular death worldwide. Its clinical presentation is heterogeneous and often nonspecific, contributing to delayed diagnosis and variable outcomes. Diagnosis relies on clinical probability assessment, D-dimer testing, and selective imaging, while the YEARS algorithm and age-adjusted D-dimer thresholds reduce unnecessary computed tomography pulmonary angiography. Risk stratification integrates hemodynamic status, right ventricular dysfunction, and cardiac biomarkers, and the 2026 American Heart Association (AHA)/American College of Cardiology (ACC) Acute PE Clinical Categories (A–E) provide a contemporary framework for clinical decision-making. Anticoagulation remains the cornerstone of treatment, whereas reperfusion therapies are reserved for high-risk PE and selected patients with clinical deterioration. This review summarizes current evidence on the pathophysiology, diagnosis, risk stratification, and management of acute PE, incorporating recommendations from the 2019 European Society Of Cardiology/European Respiratory Society guideline, the 2026 AHA/ACC/Multisociety guideline, the 2024 NAMS (India) Task Force report, and recent Indian data.