{"id":"46091","type":"article","url":"https://hartvaat.nl/2026/04/10/risicostratificatie-bij-longembolie-hoe-bruikbaar-zijn-de-huidige-instrumenten/","title":"Risicostratificatie bij longembolie: hoe bruikbaar zijn de huidige instrumenten?","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Heart","doi":"http://heart.bmj.com/cgi/content/short/112/9/480?rss=1","source_url":"https://doi.org/http://heart.bmj.com/cgi/content/short/112/9/480?rss=1","authors":["Stenger","W. J. E.","den Uil","C. A.","Rietdijk","W. J. R.","Kraaijeveld","A. O.","Klok","F. A."],"significance":5,"published":"2026-07-24","source_date":"2026-04-10","image":"https://hartvaat.nl/global/img/5e97691e9888.webp","kennis":["https://hartvaat.nl/kennis/coronairlijden/troponine-interpretatie/","https://hartvaat.nl/kennis/kleplijden/esc-richtlijn-kleplijden-2021/"],"congress":"","summary_en":"International guidelines recommend risk stratification of acute pulmonary embolism (PE) to guide treatment. Key prognostic factors include clinical presentation, comorbidities, (imaging) biomarkers and haemodynamic status. The most widely used algorithm, from the 2019 ESC/ERS guideline, classifies patients as high-risk (massive), intermediate-risk (submassive, high or low) and low-risk (non-massive), with the risk of adverse outcomes rising at each level. Yet leading guidelines differ substantially in their risk classification and corresponding treatment recommendations, owing to a lack of top-level (1A) evidence. This review evaluates current stratification tools and identifies the main knowledge gaps — relevant to the everyday choice between outpatient treatment, admission or reperfusion in PE.","created":"2026-07-03T20:27:18Z","updated":"2026-07-04T19:09:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Internationale richtlijnen bevelen risicostratificatie van acute longembolie (LE) aan om de behandeling te sturen. Belangrijke prognostische factoren zijn de klinische presentatie, comorbiditeit, (beeldvormings)biomarkers en de hemodynamische status. Het meest gebruikte algoritme, uit de ESC/ERS-richtlijn van 2019, deelt patiënten in als hoog-risico (massaal), intermediair-risico (submassaal, hoog of laag) en laag-risico (niet-massaal), waarbij het risico op ongunstige uitkomsten met elk niveau stijgt. Toch verschillen toonaangevende richtlijnen aanzienlijk in hun risico-indeling en bijbehorende behandeladviezen, door een gebrek aan bewijs van het hoogste niveau (1A). Dit overzicht evalueert de huidige stratificatie-instrumenten en benoemt de belangrijkste kennishiaten — relevant voor de dagelijkse keuze tussen poliklinische behandeling, opname of reperfusie bij longembolie.","abstract_original":"<p>Currently, most international guidelines advocate for risk stratification of acute pulmonary embolism (PE) as a framework to guide treatment decisions. Key prognostic factors for patients with PE include clinical presentation, comorbidities, (imaging) biomarkers and haemodynamic status. The most widely used risk stratification algorithm, outlined in the 2019 European Society of Cardiology/European Respiratory Society guidelines, classifies patients with PE into high-risk (massive), (high or low) intermediate-risk (submassive) and low-risk (nonmassive) categories. It is well established that the risk of adverse outcomes, including mortality, increases with each escalating risk level. However, substantial variation remains among leading international guidelines regarding risk stratification and corresponding treatment recommendations. This inconsistency stems from a lack of grade/level 1A evidence (i.e. strong recommendation based on high-quality evidence) to guide treatment decisions"}