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The quick Sequential Organ Failure Assessment (qSOFA) score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism (PE) by combining with electrocardiography (ECG).Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low - risk groups by imaging and biomarkers. The ECG scores consisted of tachycardia, McGinn-White sign (S1Q3T3), right bundle branch block, and T-wave inversion of leads V1–V3. A new combination of qSOFA scores and ECG scores by logistic regression for predicting high-risk stratification patients with acute PE was evaluated by a receiver operating characteristic curve.Totally 1318 patients were enrolled, including 271 in the high-risk group and 1047 in the low-risk group. A combination predictive scoring system named qSOFA-ECG = qSOFA score + ECG score was created. The optimal cutoff value for qSOFA-ECG was 2, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.5%, 72.3%, 43.2%, and 93.8%, respectively. For predicting high-risk stratification and reperfusion therapy, the qSOFA-ECG is superior to PE Severity Index (PESI) and simplified PESI.The qSOFA score contributes to identify acute PE patients with potentially hemodynamic decompensation that need monitoring and possible reperfusion therapy at the emergency department arrival when used in combination with ECG score.