Despite no difference in baseline demographics and comorbidities, patients with massive APE had a higher frequency of acute kidney injury (P = 0.005) and a higher lactic acid (P = 0.011), cardiac troponin I (P = 0.001) and B-type natriuretic peptide (P < 0.001), a higher frequency of RV dilation (P = 0.017) and hypokinesis (P = 0.003), higher requirement of mechanical ventilation (P < 0.001) and higher in-hospital mortality (15.2% vs. 2%, P < 0.001). Here, TNNI3 is linked to apparent mineralocorticoid excess.