Aims The 2019 European Society of Cardiology (ESC) guidelines provide a revised definition of high-risk pulmonary embolism (PE) encompassing three clinical presentations: Cardiac arrest, obstructive shock, and persistent hypotension. This study investigated the prognostic implications of this new definition. Methods and results Data from 784 consecutive PE patients prospectively enrolled in a single-centre registry were analysed. Study outcomes include an in-hospital adverse outcome (PE-related death or cardiopulmonary resuscitation) and in-hospital all-cause mortality. Overall, 86 patients (11.0%) presented with high-risk PE and more often had an adverse outcome (43.0%) compared to intermediate-high-risk patients (6.1%; P < 0.001). Patients with cardiac arrest had the highest rate of an in-hospital adverse outcome (78.4%) and mortality (59.5%; both P < 0.001 compared to intermediate-high-risk patients). Obstructive shock and persistent hypotension had similar rates of adverse outcomes (15.8% and 18.2%, respectively; P = 0.46), but the only obstructive shock was associated with an increased all-cause mortality risk. Use of an optimised venous lactate cut-off value (3.8 mmol/L) to diagnose obstructive shock allowed differentiation of adverse outcome risk between patients with shock (21.4%) and persistent hypotension (9.5%), resulting in a net reclassification improvement (0.24 ± 0.08; P = 0.002). Conclusion The revised ESC 2019 guidelines definition of high-risk PE stratifies subgroups at different risk of in-hospital adverse outcomes and all-cause mortality. Risk prediction can be improved by using an optimised venous lactate cut-off value to diagnose obstructive shock, which might help to better assess the risk-to-benefit ratio of systemic thrombolysis in different subgroups of high-risk patients.

中文翻译：

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不同临床表现的高危肺栓塞患者结局

目的 2019 年欧洲心脏病学会 (ESC) 指南提供了高危肺栓塞 (PE) 的修订定义，包括三种临床表现：心脏骤停、阻塞性休克和持续性低血压。本研究调查了这一新定义的预后意义。方法和结果 分析了前瞻性纳入单中心登记的 784 名连续 PE 患者的数据。研究结果包括院内不良结果（PE相关死亡或心肺复苏）和院内全因死亡率。总体而言，与中高危患者（6.1%；P < 0.001）相比，86 名患者（11.0%）出现高危 PE，并且更常出现不良结果（43.0%）。心脏骤停患者的院内不良结局发生率（78.4%）和死亡率（59. 5%；P＜0.001 与中高风险患者相比）。阻塞性休克和持续性低血压的不良结局发生率相似（分别为 15.8% 和 18.2%；P = 0.46），但唯一的阻塞性休克与全因死亡风险增加有关。使用优化的静脉乳酸临界值 (3.8 mmol/L) 来诊断阻塞性休克，可以区分休克患者 (21.4%) 和持续性低血压 (9.5%) 患者的不良结局风险，从而实现净重新分类改善 (0.24 ± 0.08；P = 0.002）。结论 修订后的 ESC 2019 指南对高危 PE 的定义对院内不良结局和全因死亡风险不同的亚组进行了分层。通过使用优化的静脉乳酸临界值来诊断阻塞性休克，可以改​​善风险预测，