Central embolic localization in acute pulmonary embolism: Prognostic marker or target for intervention?
In brief
Central clot location doubles risk of PE-related death in acute pulmonary embolism
In a nationwide Italian cohort of 4,415 symptomatic PE patients, 61% had central emboli. Central location did not change overall 30-day mortality but was linked to roughly twice the rate of death directly attributable to PE (1.7% vs 0.6%) and a modest rise in death or clinical deterioration. The finding may help identify intermediate-risk patients for closer attention, though hemodynamic compromise remains the chief driver of poor outcomes.
- Journal
- European journal of internal medicine (Q1)
- Published
- 21 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Maria Cristina Vedovati, Ludovica Anna Cimini, Iolanda Enea, Manuela Romei, Giulio Righini, Giuseppe Pio Martino, et al.
- PMID
- 42767924
- DOI
- 10.1016/j.ejim.2026.107174
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 24 September 2026): Central embolic localization prognostic value in acute pulmonary embolism
Abstract
BACKGROUND: In patients with acute pulmonary embolism (PE), computed tomography pulmonary angiography (CTPA) enables both diagnosis and prognosis. This analysis of symptomatic acute PE patients aims to describe clinical features, management, and short-term outcomes by embolic localization, and to assess the prognostic value of central emboli. METHODS: COPE (COntemporary management of acute Pulmonary Embolism) is a nationwide Italian cohort study run in Internal Medicine, Cardiology and Emergency Departments including 5,213 patients with symptomatic, objectively confirmed acute PE. Patients with data on embolic localization available were included in this analysis. RESULTS: Overall, 4,415 patients were included; 61.5% with central, 33.2% with segmental and 5.3% with subsegmental embolic localization. Central PE was found in 85.4% and in 83.7% of patients at high or at intermediate-high risk according to ESC 2019. Central embolic localization was not associated with all-cause death at 30 days, but was an independent predictor of PE-related death (1.7% vs 0.6%, HR 2.11, 95% CI 1.08-4.11) and of death or clinical deterioration (7.2% vs 5.7%, HR 1.37, 95% CI 1.05-1.79) compared to segmental/subsegmental localization. Among intermediate-risk patients according to the ESC classification, central PE was able to identify those at higher risk of PE-related death (1.6% vs 0.4%, HR 4.69, 95% CI 1.67-13.22). CONCLUSIONS: In patients with acute PE, the main determinant of a poor outcome is hemodynamic compromise. Central localization of emboli is not associated to all-cause-death, but could be used to identify intermediate-low risk patients at increased risk for PE-related death.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.