Objective To investigate the predictive value of chest CT imaging characteristics for risk stratification of acute pulmo-nary embolism(APE)in the plateau area.Methods A total of 202 patients diagnosed with APE for the first time were retrospec-tively selected.According to clinical risk stratification criteria,all patients were categorized into low-risk group(104 cases)and medium/high-risk group(98 cases).Demographic characteristics and chest CT image parameters of patients were collected,including gender,age,ascending aorta diameter(AAd),main pulmonary artery diameter(MPAd),the ratio of main pulmonary artery diameter to ascend-ing aorta diameter(r PA),pulmonary artery obstruction index(PAOI),PAOI grade,emphysema,atelectasis,pulmonary consolida-tion,pleural effusion,pericardial effusion,and pulmonary atelectasis.All these parameters between the two groups were compared and statistically analyzed.Results There was a statistically significant difference between the two groups in age,MPAd,r PA,PAOI grade,emphysema,and pericardial effusion(P<0.05).No statistically significant difference was showed in gender,AAd,PAOI,ate-lectasis,pulmonary consolidation,pleural effusion,and pulmonary atelectasis between the two groups(P>0.05).The logistic regres-sion analysis showed that age,r PA,PAOI grade,and pericardial effusion were independent factors for risk stratification of APE.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was 0.654,0.699,0.669,and 0.616,respectively.The combined AUC was 0.843,with a sensitivity of 76.5%and a specificity of 77.9%.Conclusion Chest CT imaging characteris-tics such as r PA,PAOI grade,and pericardial effusion combined with patient age have important predictive value for risk stratification of APE in the plateau area.