Abstract: Objective To retrospectively analyze the electrocardiogram(ECG) manifestations of acute pulmonary embolism(APE) patients, aiming to explore the relationship between ECG manifestations and risk stratification of APE. Methods A total of 74 patients with APE in the First Affiliated Hospital of Wannan Medical College from February 2017 to January 2020 were collected. According to the "2019 ESC/ERS Guidelines for the diagnosis and management of APE", they were divided into high-risk group(21 cases) and medium-low risk group(53 cases). ECG manifestations and other auxiliary examination results of the two groups were compared. Results Compared with APE in High-risk and medium-low risk group, there were significant differences in the sinus tachycardia, S_ⅠQ_ⅢT_Ⅲ, right bundle branch block, V1 in Qr, V1-V4 NTW, and QTC interval prolongation(P<0.05). Multivariate logistic regression analysis was performed on the number of six ECG manifestations, age, gender, history of venous thrombosis, history of surgery/rauma, history of tumor, troponin I positive, BNP and d-dimer, the results showed that the odds ratio of six ECG manifestations for high-risk APE was 6.445(P<0.05, 95% CI: 2.688-15.453). ROC curve was drawn according to the distribution of the number of different ECG findings in the medium-low risk groups and the high risk groups, the results showed that the area under the ROC curve(AUC) was 0.912, Youden index was 0.772, sensitivity was 90.48, specificity was 86.79, and cutoff value was greater than 1. Conclusion Compared with APE in the low-risk group, sinus tachycardia, S_ⅠQ_ⅢT_Ⅲ, right bundle branch block, V1 showed Qr, V1-V4 NTW, and QTC interval prolongation are more common in the high-risk group. The more the number of six ECG manifestations, the greater the risk of high-risk APE.