{"id":9555,"date":"2026-02-21T19:50:53","date_gmt":"2026-02-21T16:50:53","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=9555"},"modified":"2026-02-21T19:50:53","modified_gmt":"2026-02-21T16:50:53","slug":"2026-acc-aha-acute-pulmonary-embolism-guideline","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/2026-acc-aha-acute-pulmonary-embolism-guideline\/","title":{"rendered":"2026 ACC\/AHA Acute Pulmonary Embolism Guideline"},"content":{"rendered":"
2026 ACC\/AHA Acute Pulmonary Embolism Guideline<\/div>\n
<\/div>\n
Risk Stratification by Clinical Categories (A\u2013E)<\/div>\n
<\/div>\n
Published Feb 19, 2026, JACC & Circulation<\/div>\n
ACC \/ AHA<\/div>\n
<\/div>\n
Acute PE Clinical Categories \u2014 Key Clinical Signs at Each Stage (Including Oxygen)<\/div>\n
<\/div>\n
A-Category A \u2014 Asymptomatic \/ Subclinical PE<\/div>\n
<\/div>\n
Clinical Signs:<\/div>\n
\u2022 Incidentally detected PE (often on CT)<\/span><\/div>\n
\u2022 No dyspnea<\/span><\/div>\n
\u2022 No chest pain<\/span><\/div>\n
\u2022 Normal blood pressure<\/span><\/div>\n
\u2022 Normal heart rate<\/span><\/div>\n
\u2022 No RV dysfunction<\/span><\/div>\n
\u2022 Normal cardiac biomarkers<\/span><\/div>\n
\u2022 Oxygenation: SpO\u2082 \u2265 95% on room air (no oxygen requirement)<\/span><\/div>\n
<\/div>\n
Management Signal:<\/div>\n
No hospitalization required<\/div>\n
Outpatient management appropriate<\/div>\n
<\/div>\n
B-Category B \u2014 Symptomatic \/ Low Clinical Severity<\/div>\n
<\/div>\n
Clinical Signs:<\/div>\n
\u2022 Dyspnea or pleuritic chest pain<\/span><\/div>\n
\u2022 Stable hemodynamics<\/span><\/div>\n
\u2022 Normal blood pressure<\/span><\/div>\n
\u2022 No signs of RV dysfunction<\/span><\/div>\n
\u2022 Normal or minimally elevated biomarkers<\/span><\/div>\n
\u2022 Oxygenation: SpO\u2082 \u2265 94% on room air (typically no oxygen; may need brief low-flow if borderline)<\/span><\/div>\n
<\/div>\n
Management Signal:<\/div>\n
-Early discharge possible<\/div>\n
-Anticoagulation main therapy<\/div>\n
<\/div>\n
C-Category C \u2014 Elevated Clinical Severity<\/div>\n
<\/div>\n
Clinical Signs:<\/div>\n
\u2022 Symptomatic PE<\/span><\/div>\n
\u2022 Evidence of RV dysfunction on echo or CT<\/span><\/div>\n
\u2022 Elevated troponin and\/or BNP<\/span><\/div>\n
\u2022 Stable blood pressure<\/span><\/div>\n
\u2022 No overt shock<\/span><\/div>\n
\u2022 Oxygenation: SpO\u2082 90\u201394% on room air (mild\u2013moderate hypoxemia; may require low-flow oxygen)<\/span><\/div>\n
<\/div>\n
Management Signal:<\/div>\n
Hospital admission required<\/div>\n
Close monitoring<\/div>\n
Consider escalation if deterioration<\/div>\n
<\/div>\n
D-Category D \u2014 Early Cardiopulmonary Failure<\/div>\n
<\/div>\n
Clinical Signs:<\/div>\n
\u2022 Transient hypotension<\/span><\/div>\n
\u2022 Borderline systolic BP<\/span><\/div>\n
\u2022 Tachycardia<\/span><\/div>\n
\u2022 Worsening hypoxia<\/span><\/div>\n
\u2022 Signs of RV strain<\/span><\/div>\n
\u2022 Rising lactate possible<\/span><\/div>\n
\u2022 Oxygenation: SpO\u2082 < 90% on room air (usually requires supplemental oxygen; rising requirement is a red flag)<\/span><\/div>\n
<\/div>\n
Management Signal:<\/div>\n
Hospitalization mandatory<\/div>\n
Consider advanced therapies<\/div>\n
Multidisciplinary evaluation<\/div>\n
<\/div>\n
E-Category E \u2014 Severe Cardiopulmonary Failure<\/div>\n
<\/div>\n
Clinical Signs:<\/div>\n
\u2022 Persistent hypotension<\/span><\/div>\n
\u2022 Cardiogenic shock<\/span><\/div>\n
\u2022 Cardiac arrest<\/span><\/div>\n
\u2022 Severe hypoxia<\/span><\/div>\n
\u2022 Marked RV failure<\/span><\/div>\n
\u2022 Multiorgan hypoperfusion<\/span><\/div>\n
\u2022 Oxygenation: SpO\u2082 < 85% or refractory hypoxemia despite oxygen (may require high-flow\/NIV\/intubation)<\/span><\/div>\n
<\/div>\n
Management Signal:<\/div>\n
ICU care<\/div>\n
Immediate advanced intervention:<\/div>\n
\u2022 Systemic thrombolysis<\/span><\/div>\n
\u2022 Catheter-directed therapy<\/span><\/div>\n
\u2022 Mechanical thrombectomy<\/span><\/div>\n
\u2022 Surgical embolectomy<\/span><\/div>\n
<\/div>\n
Clinical Insight<\/div>\n
<\/div>\n
The A\u2013E framework builds an escalation ladder using:<\/div>\n
Objective clinical severity<\/div>\n
Hemodynamic status<\/div>\n
RV involvement<\/div>\n
Biomarker elevation<\/div>\n
Oxygenation trend and oxygen requirement (especially for D\u2013E)<\/div>\n
<\/div>\n
D-dimer:<\/div>\n
\u2022 Diagnostic screening tool (not severity marker)<\/span><\/div>\n
\u2022 High sensitivity<\/span><\/div>\n
\u2022 Used to rule out PE in low-risk patients<\/span><\/div>\n
\u2022 Not useful for risk stratification once PE is confirmed<\/span><\/div>\n
<\/div>\n
Key reminder: SpO\u2082 alone does not define risk\u2014some high-risk patients can initially have near-normal oxygenation if RV strain\/hemodynamics are deteriorating.<\/div>\n
<\/div>\n
https:\/\/www.jacc.org\/doi\/10.1016\/j.jacc.2025.11.005<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

2026 ACC\/AHA Acute Pulmonary Embolism Guideline Risk Stratification by Clinical Categories (A\u2013E) Published Feb 19, 2026, JACC & Circulation ACC \/ AHA Acute PE Clinical Categories \u2014 Key Clinical Signs at Each Stage (Including Oxygen) A-Category A \u2014 Asymptomatic \/ Subclinical PE Clinical Signs: \u2022 Incidentally detected PE (often on CT) \u2022 No dyspnea \u2022 […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9555","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9555","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=9555"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9555\/revisions"}],"predecessor-version":[{"id":9556,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9555\/revisions\/9556"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=9555"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=9555"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=9555"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}