Sudden death can be the initial presentation of pulmonary embolism and early fatality is substantial among patients who present with haemodynamic instability [1,2]. Death from pulmonary embolism, namely with pulmonary embolism starting the chain of medical events leading to death, remains a major contributor to cardiovascular mortality in Europe [3] and the United States [4]. Raising general awareness, a broader implementation of available preventive and diagnostic strategies, better criteria to identify higher risk patients, and safer reperfusion regimens represent unmet needs to reduce global pulmonary embolism-related mortality [2,5–8].