ESC PE risk class

Assigns the ESC 2019 early mortality risk class of confirmed PE: haemodynamic instability → high; otherwise sPESI (calculated here) or PESI class, RV dysfunction on echo or CTPA, and cardiac troponin set intermediate-high (both RV dysfunction and raised troponin), intermediate-low or low risk. The matching ACC/AHA 2026 clinical category (A–E) and management from both guidelines are shown side by side.

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1. Haemodynamic status

2. Clinical severity

Calculate sPESI here, or enter a known PESI class

3. RV and myocardial injury

ESC 2019 early mortality risk

Low risk

ACC/AHA 2026 category B2

PESI I–II / sPESI 0, no RV dysfunction, troponin normal (if tested): 30-day mortality ≈ 1%

Management

ESC

DOAC (apixaban, rivaroxaban, edoxaban, dabigatran)
Class IESC 2019
Preferred over LMWH-VKA unless severe renal impairment, APS, pregnancy or breastfeeding.
Early discharge or home treatment
IIaESC 2019
If Hestia criteria are absent and proper outpatient care can be provided.

ACC/AHA 2026

Use Hestia, PESI or sPESI to select early discharge / home treatment
Class 1ACC/AHA 2026
Thrombus burden should not be used to stratify risk (Class 3: No Benefit).
DOAC over VKA
Class 1ACC/AHA 2026
Unless APS (warfarin), pregnancy (LMWH; DOAC/VKA harmful) or Child-Pugh C liver disease.
Do not give systemic thrombolysis instead of anticoagulation alone
Class 3: HarmACC/AHA 2026
Increases major bleeding and intracranial haemorrhage without benefit.
Follow-up contact ~1 week after discharge and a visit within 3 months
Class 1ACC/AHA 2026
Ask about dyspnoea and function for ≥ 1 year (CTEPD screening).

References