STAMP Score Predicts Crashing in Intermediate-High Risk PE

Written by Samuel Rouleau

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The newly derived and validated STAMP score predicts clinical decompensation in patients with acute PE who are classified as intermediate-high risk per ESC guidelines.

Let’s STAMP down mortality from PE!
Among patients with acute PE, approximately 10% of those classified as intermediate-high risk by ESC guidelines will decompensate. These patients 1) are hemodynamically stable, 2) have right heart strain on CT or echo, and 3) have abnormal labs (troponin or BNP). Identifying which patients may decompensate and potentially benefit from primary reperfusion therapy is tricky. The STAMP score is great progress in identifying this subgroup.

450 patients were classified as intermediate-high risk PE; 270 were randomized to the derivation cohort and 180 to validation. After multivariate analysis, 5 variables were identified: syncope (+2 points), age ≥ 65 (+1 point), chest pain (+1 point), MAP ≤ 81.5 (+2 points), and TAPSE to PASP ratio ≤ 0.33 (+2 points). Low risk was defined as 0 to 2, intermediate risk 3 to 5, and high risk 6 to 8. After validation, the AUC was 0.85 (95%CI 0.82-0.88). Decompensation increased with each STAMP score range 0%, 42.8%, and 57.1%. When looking at individual variables, syncope had the highest coefficient for deterioration (1.74) and positive predictive value (86%).

How will this change my practice?
Further validation must be done, but clinicians should include these variables when evaluating patients with intermediate-high risk PE, as it may guide disposition and management.

• History matters! Syncope is a known predictor of decompensation and mortality in PE––but don’t forget to ask about pre-syncope.
• Chest pain may perform differently in future validation studies. This study included a majority of men, and women have different PE symptomatology. 
• My biggest critique is reliance on the TAPSE/PASP ratio. TAPSE can be easily done at the bedside. PASP is an advanced echocardiographic maneuver (color doppler of TR jet and estimating RA pressure). While I understand the rationale (shows potential RV–PA decoupling), it is unrealistic for emergency clinicians to perform PASP measurements at the bedside.

Source 
The STAMP score: An exploratory model for short-term risk stratification in intermediate-high-risk pulmonary embolism running head: The STAMP score. Eur J Intern Med. 2025 Aug 20:106484. doi: 10.1016/j.ejim.2025.106484. Epub ahead of print. PMID: 40841246.