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Eur J Intern Med. 2018 Aug;54:27-33. doi: 10.1016/j.ejim.2018.04.004. Epub 2018 Apr 11.

Impact of syncope and pre-syncope on short-term mortality in patients with acute pulmonary embolism.

Author information

1
Department of Cardiology, Rovigo General Hospital, Rovigo, Italy. Electronic address: roncon.loris@azisanrovigo.it.
2
Department of Cardiology, Rovigo General Hospital, Rovigo, Italy; Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy.
3
Department of Cardiology, San Carlo Borromeo Hospital, Milan, Italy.
4
Internal Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
5
Department of Cardiology, Ospedali dell'Ovest Vicentino, Arzignano, Italy.
6
Department of Cardiology, Rovigo General Hospital, Rovigo, Italy.

Abstract

BACKGROUND:

Syncope and pre-syncope are well-known symptoms of acute pulmonary embolism (PE). However, data about their impact on short-term mortality are scant. We assess the short-term mortality (30-day) for all-causes in PE patients admitted with syncope or with pre-syncope, according their hemodynamic status at admission.

METHODS:

Patients from the prospective Italian Pulmonary Embolism Registry (IPER) were included in the study. At admission, subjects were stratified according to 2008 ESC guidelines (as high- and non-high-risk patients).

RESULTS:

Among the 1716 patients with confirmed acute PE, syncope or pre-syncope was the initial manifestation of the disease in 458 (26.6%) patients. Short-term mortality (30-day) for all causes were significantly higher in patients with syncope/presyncope (42.5% vs 6.2%, p < 0.0001) while PE patients with presyncope demonstrated a worst short-term outcome, in terms of mortality for all-causes, when compared to those subjects with syncope at admission (47.2% vs 37.4%, p = 0.03). A statistically significant difference in survival between pre-syncope and syncope was observed only in hemodynamically unstable patients [log rank p = 0.036]. Cox regression analysis confirmed that pre-syncope resulted an independent predictor of 30-day mortality in hemodynamically unstable patients at admission (HR 2.13, 95% CI 1.08-4.22, p = 0.029), independently from right ventricular dysfunction (RVD) (HR 6.23, 95% CI 3.05-12.71, p < 0.0001), age (HR 1.03, 95% CI 1.00-1.06, p = 0.023) and thrombolysis (HR 2.27, 95% CI 1.11-4.66, p = 0.025).

CONCLUSIONS:

PE patients with syncope/presyncope had a higher 30-day mortality for all-causes as well as patients with presyncope had a worst short-term outcome when compared to PE patients with syncope. Moreover, hemodynamically unstable patients with presyncope had a worst prognosis independently from the presence of RVD, age, positive cTn and thrombolytic treatment.

KEYWORDS:

Collapse; Mortality; Pulmonary embolism; Syncope

PMID:
29655808
DOI:
10.1016/j.ejim.2018.04.004
[Indexed for MEDLINE]

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