Electrocardiographic Prediction of Acute Pulmonary Embolism at Intermediate-High- and High-Risk.

Background: Acute pulmonary embolism (PE) is a life-threatening condition, and the diagnosis of acute PE remains difficult. Methods and Results: In all, 133 consecutive patients with acute PE (mean [±SD] age 72±17 years, 53 men) were classified into 4 groups based on the severity of PE: high risk (n=12); intermediate-high risk (n=86); intermediate-low risk (n=1); and low risk (n=34). After excluding the 1 patient with intermediate-low-risk PE, clinical characteristics, the high-, intermediate-high-, and low-risk groups were compared: T wave inversion (V1-V3) was seen in 83%, 56%, and 18% of patients, respectively (P<0.001); an S1Q3T3 pattern was seen in 75%, 35%, and 0% of patients, respectively (P<0.001); echocardiographic evidence of right ventricular (RV) dysfunction was seen in 100%, 86%, and 0% of patients, respectively (P<0.001); the median (interquartile range) door-to-treatment time (n=11, 44, and 15, respectively) was 65 (43-116), 116 (78-213), and 183 (104-222) min, respectively (P<0.01); and the in-hospital death rate was 50%, 1%, and 0%, respectively (P<0.001). Multivariate analysis revealed that T wave inversion and an S1Q3T3 pattern were independently associated with intermediate-high- and high-risk acute PE, with adjusted odds ratios (95% confidence intervals) of 5.85 (2.14-15.96; P=0.0006) and 4.31 (1.65-11.27; P=0.0029), respectively. Conclusions: Electrocardiographic evidence of right precordial T wave inversion and an S1Q3T3 pattern, followed by echocardiographic confirmation of RV dysfunction, may help with the early diagnosis of intermediate-high- and high-risk acute PE and thus contribute to improved door-to-treatment times and the prevention of adverse outcomes.