Is it time for a myocardial infarction approach to high- and intermediate-high-risk pulmonary embolism?

As risk stratification for acute pulmonary embolism (PE) has evolved over the past two decades, important parallels to the approach to myocardial infarction (MI) have emerged. The integration of clinical factors, cardiac biomarkers, electrocardiographic findings, and cardiac imaging characterise the assessment of both disorders. Furthermore, high- and intermediate-high-risk PE share similarities with those experiencing ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). First, high- and intermediate-high-risk PE patients demonstrate a similarly elevated risk of in-hospital mortality compared with those presenting with STEMI and NSTEMI12. Second, the acute care of these life-threatening cardiovascular conditions is based on a similar team-based approach, represented by STEMI teams and pulmonary embolism response teams (PERTs), respectively3. In MI, early reperfusion therapy is aimed at restoring coronary artery blood flow and preventing myocardial necrosis and the decline of left ventricular systolic function12. Similarly, in high- and intermediate-high-risk PE patients with clinical deterioration, reperfusion therapy is aimed at restoring pulmonary blood flow, improving gas exchange, and alleviating right ventricular dysfunction (RVD)1. Additionally, the benefit of reperfusion appears to be time dependent in...