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Maestre A, Escribano JC, Lobo JL, Jara-Palomares L, Jiménez D, Bikdeli B, Armestar F, Bura-Riviere A, Lorenzo A, Monreal M. Major bleeding in patients with pulmonary embolism presenting with syncope. Eur J Clin Invest 2022; 52:e13774. [PMID: 35302666 DOI: 10.1111/eci.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Syncope has been shown to be a risk factor of bleeding in patients receiving thrombolytic therapy for acute pulmonary embolism (PE). Whether syncope predicts bleeding in a broader population of patients with PE remains unknown. METHODS We used the RIETE registry data to assess whether initial presentation with syncope could predict bleeding in PE patients receiving anticoagulant therapy, and to explore the association between presence of syncope and timing and site of major bleeding events. RESULTS Among 45,765 patients with acute PE from March 2001 to January 2021, 6760 (14.8%) had syncope. Patients with syncope were older and more likely to have hypotension, tachycardia, hypoxaemia or elevated troponin levels than those without syncope. They also were more likely to receive thrombolytics. During the first 90 days, 1097 patients (2.4%) suffered major bleeding (gastrointestinal 335, hematoma 271 and intracranial 163) and 3611 died (158 had fatal bleeding). Patients with syncope had a higher rate of major bleeding (odds ratio [OR]: 1.63; 95% CI: 1.41-1.89) and a nonsignificantly higher rate of fatal bleeding (OR: 1.47; 95% CI: 0.99-2.17) than those without syncope. Multivariable analysis confirmed that patients with syncope were at increased risk for major bleeding (adjusted hazard ratio [aHR]: 1.34; 95% CI: 1.15-1.55). On sensitivity analysis, the increased risk for major bleeding was confirmed in patients initially receiving anticoagulant therapy without thrombolytics at 7 days (aHR: 1.47; 95% CI: 1.13-1.91) and 90 days (aHR: 1.33; 95%CI: 1.13-1.56). DISCUSSION Syncope is a predictor of major bleeding events in patients with PE, even among those receiving anticoagulation monotherapy.
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Affiliation(s)
- Ana Maestre
- Department of Internal Medicine, Hospital Universitario del Vinalopo, Elche, Spain.,Medicine Department, Universidad Catolica San Antonio de Murcia, Murcia, Spain
| | | | - José Luis Lobo
- Respiratory Department, Hospital Universitario Araba, Álava, Spain
| | - Luis Jara-Palomares
- Respiratory Department, Hospital Universitario Virgen del Rocío and Instituto de Biomedicina, Sevilla, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain.,Medicine Department, Universidad de Alcala, Madrid, Spain
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Yale/YNHH Center for Outcomes Research & Evaluation (CORE), New Haven, Connecticut, USA.,Cardiovascular Research Foundation (CRF), New York, New York, USA
| | - Fernando Armestar
- Department of Intensive Care Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Alicia Lorenzo
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.,Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM-Universidad Católica San Antonio de Murcia, Murcia, Spain
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Mohebali D, Heidinger BH, Feldman SA, Matos JD, Dabreo D, McCormick I, Litmanovich D, Manning WJ, Carroll BJ. Right ventricular strain in patients with pulmonary embolism and syncope. J Thromb Thrombolysis 2021; 50:157-164. [PMID: 31667788 DOI: 10.1007/s11239-019-01976-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patients with acute pulmonary embolism (PE) can present with various clinical manifestations including syncope. The mechanism of syncope in PE is not fully elucidated and data of right ventricular (RV) function in patients has been limited. We retrospectively identified 477 consecutive patients hospitalized with acute PE diagnosed with a computed tomogram (CT) who also had a transthoracic echocardiogram (TTE) 24 h prior to or 48 h after diagnosis. Parameters of RV strain on CT, TTE, electrocardiogram (ECG), and clinical characteristics and adverse outcomes were collected. Patients with all three studies available for assessment were included (n = 369) and those with syncope (n = 34) were compared to patients without syncope (n = 335). Patients with syncope were more likely to demonstrate RV strain on all three modes of assessment compared to those without syncope [17 (50%) vs. 67 (20%); p = 0.001], and those patients were more likely to receive advanced therapies [9 (53%) vs. 15 (22%); p = 0.02]. PE-related mortality was highest among those presenting with high-risk PE and syncope (36%, OR 20.1, 95% CI 5.3-81.1; p < 0.001) and was low in patients with syncope without criteria for high-risk PE (3%, OR 1.2, 95% CI 0.2-10.0; p < 0.001). In conclusion, acute PE patients with syncope are more likely to demonstrate multimodality evidence of RV strain and to receive advanced therapies. Syncope was only associated with increased PE-related mortality in patients presenting with a high-risk PE. Syncope alone without evidence of RV strain is associated with low short-term adverse events and is similar to those without syncope.
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Affiliation(s)
- Donya Mohebali
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA
| | - Benedikt H Heidinger
- Radiology and Harvard Medical School, Boston, MA, USA.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephanie A Feldman
- Department of Medicine (Section of Cardiovascular Medicine), Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jason D Matos
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA
| | | | - Ian McCormick
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA
| | - Diana Litmanovich
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Radiology and Harvard Medical School, Boston, MA, USA
| | - Warren J Manning
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA.,Radiology and Harvard Medical School, Boston, MA, USA
| | - Brett J Carroll
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA, 02215, USA.
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de Winter MA, van Bergen EDP, Welsing PMJ, Kraaijeveld AO, Kaasjager KHAH, Nijkeuter M. The Prognostic Value of Syncope on Mortality in Patients With Pulmonary Embolism: A Systematic Review and Meta-analysis. Ann Emerg Med 2020; 76:527-541. [PMID: 32461009 DOI: 10.1016/j.annemergmed.2020.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE Syncope is a presenting symptom in 10% to 20% of patients with pulmonary embolism. We perform a meta-analysis to clarify the prognostic value of syncope on short-term mortality in pulmonary embolism patients and its association with hemodynamic instability. METHODS PubMed, EMBASE, and the Cochrane Library were searched up until January 7, 2020. Studies reporting inhospital or 30-day mortality of adults with pulmonary embolism with and without syncope were included. Quality of included studies was evaluated with the Quality in Prognosis Studies tool. Meta-analysis was conducted to derive pooled odds ratios (ORs) and risk differences for the relation of syncope with mortality and hemodynamic instability. To study the influence of hemodynamic instability on the association between syncope and mortality, meta-regression was performed. RESULTS Search and selection resulted in 26 studies, of which 20 were pooled, involving 9,419 of 335,120 patients (3%) with syncope. Syncope was associated with higher mortality (OR 1.82; 95% confidence interval [CI] 1.14 to 2.90; I2 88%; risk difference 4% [95% CI 1% to 8%]) and higher prevalence of hemodynamic instability (OR 4.36; 95% CI 2.27 to 8.37; I2 93%; risk difference 12% [95% CI 7% to 18%]). OR for mortality in patients with pulmonary embolism with syncope versus without it was higher in the presence of a larger difference in hemodynamic instability between groups (coefficient 0.05; 95% CI 0.01 to 0.09). CONCLUSION The association between syncope and short-term mortality in patients with pulmonary embolism is explained by a difference in hemodynamic instability. This emphasizes the importance of risk stratification by hemodynamic status in pulmonary embolism patients with and without syncope.
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Affiliation(s)
- Maria A de Winter
- Department of Internal Medicine, UMC Utrecht, Utrecht, the Netherland.
| | | | - Paco M J Welsing
- Department of Internal Medicine, UMC Utrecht, Utrecht, the Netherland
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Vinson DR, Engelhart DC, Bahl D, Othieno AA, Abraham AS, Huang J, Reed ME, Swanson WP, Clague VA, Cotton DM, Krauss WC, Mark DG. Presyncope Is Associated with Intensive Care Unit Admission in Emergency Department Patients with Acute Pulmonary Embolism. West J Emerg Med 2020; 21:703-713. [PMID: 32421523 PMCID: PMC7234693 DOI: 10.5811/westjem.2020.2.45028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/04/2020] [Accepted: 02/12/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without syncope. Whether presyncope carries the same prognostic implications has not been established. We compared incidence of intensive care unit (ICU) admission in three groups of ED PE patients: those with presyncope; syncope; and neither. METHODS This retrospective cohort study included all adults with acute, objectively confirmed PE in 21 community EDs from January 2013-April 2015. We combined electronic health record extraction with manual chart abstraction. We used chi-square test for univariate comparisons and performed multivariate analysis to evaluate associations between presyncope or syncope and ICU admission from the ED, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Among 2996 PE patients, 82 (2.7%) had presyncope and 109 (3.6%) had syncope. ICU admission was similar between groups (presyncope 18.3% vs syncope 25.7%) and different than their non-syncope counterparts (either 22.5% vs neither 4.7%; p<0.0001). On multivariate analysis, both presyncope and syncope were independently associated with ICU admission, controlling for demographics, higher-risk PE Severity Index (PESI) class, ventilatory support, proximal clot location, and submassive and massive PE classification: presyncope, aOR 2.79 (95% CI, 1.40, 5.56); syncope, aOR 4.44 (95% CI 2.52, 7.80). These associations were only minimally affected when excluding massive PE from the model. There was no significant interaction between either syncope or presyncope and PESI, submassive or massive classification in predicting ICU admission. CONCLUSION Presyncope appears to carry similar strength of association with ICU admission as syncope in ED patients with acute PE. If this is confirmed, clinicians evaluating patients with acute PE may benefit from including presyncope in their calculus of risk assessment and site-of-care decision-making.
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Affiliation(s)
- David R. Vinson
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente Division of Research, Oakland, California
- Kaiser Permanente Sacramento Medical Center, Department of Emergency Medicine, Sacramento, California
| | | | - Disha Bahl
- St. George’s University, School of Medicine, Grenada, West Indies
| | - Alisha A. Othieno
- University of California, Davis, School of Medicine, Sacramento, California
| | - Ashley S. Abraham
- University of California, Davis, School of Medicine, Sacramento, California
| | - Jie Huang
- Kaiser Permanente Division of Research, Oakland, California
| | - Mary E. Reed
- Kaiser Permanente Division of Research, Oakland, California
| | - William P. Swanson
- University of California, Davis, School of Medicine, Sacramento, California
- Kaiser Permanente San Diego Medical Center, Department of Emergency Medicine, San Diego, California
| | - Victoria A. Clague
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente San Rafael Medical Center, Department of Radiology, San Rafael, California
| | - Dale M. Cotton
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente South Sacramento Medical Center, Department of Emergency Medicine, Sacramento, California
| | - William C. Krauss
- Kaiser Permanente San Diego Medical Center, Department of Emergency Medicine, San Diego, California
| | - Dustin G. Mark
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente Division of Research, Oakland, California
- Kaiser Permanente Oakland Medical Center, Department of Emergency Medicine, Oakland, California
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Barco S, Ende-Verhaar YM, Becattini C, Jimenez D, Lankeit M, Huisman MV, Konstantinides SV, Klok FA. Differential impact of syncope on the prognosis of patients with acute pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2019; 39:4186-4195. [PMID: 30339253 DOI: 10.1093/eurheartj/ehy631] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/18/2018] [Indexed: 01/08/2023] Open
Abstract
Aims Controversial reports exist in the literature regarding the prognostic role and therapeutic implications of syncope in patients with acute pulmonary embolism (PE). We conducted a systematic review and meta-analysis to investigate the association between syncope and short-term adverse outcomes, taking into account the presence or absence of haemodynamic compromise at acute PE presentation. Methods and results The literature search identified 1664 studies, 29 of which were included for a total of 21 956 patients with PE (n = 3706 with syncope). Syncope was associated with higher prevalence of haemodynamic instability [odds ratio (OR) 3.50; 95% confidence interval (CI) 2.67-4.58], as well as with echocardiographic signs of right ventricular (RV) dysfunction (OR 2.10; CI 1.60-2.77) at presentation. Patients with syncope had a higher risks of all-cause early (either in-hospital or within 30 days) death (OR 1.73; CI 1.22-2.47) and PE-related 30-day adverse outcomes (OR 2.00; CI 1.11-3.60). The absolute risk difference (95% CI) for all-cause death was +6% (+1% to +10%) in studies including unselected patients, but it was -1% (-2% to +1%) in studies restricted to normotensive patients. We observed no prognostic impact of syncope in studies with a lower score at formal quality assessment and in those conducted retrospectively. Conclusion Syncope as a manifestation of acute PE was associated with a higher prevalence of haemodynamic instability and RV dysfunction at presentation, and an elevated risk for early PE-related adverse outcomes. The association with an increased risk of early death appeared more prominent in studies including unselected patients, when compared with those focusing on normotensive patients only.
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Affiliation(s)
- Stefano Barco
- Center for Thrombosis and Haemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, Mainz, Germany
| | - Yvonne M Ende-Verhaar
- Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Albinusdreef 2, RC, Leiden, the Netherlands
| | - Cecilia Becattini
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, via Dottori 1, Perugia, Italy
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (IRYCIS), Ctra. Colmenar Km. 9,100, Madrid, Spain
| | - Mareike Lankeit
- Center for Thrombosis and Haemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, Mainz, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité - University Medicine Berlin, Augustenburger Platz 1, Berlin, Germany.,Clinic for Cardiology and Pneumology, Georg-August University of Göttingen, Göttingen, Germany
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Albinusdreef 2, RC, Leiden, the Netherlands
| | - Stavros V Konstantinides
- Center for Thrombosis and Haemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, Mainz, Germany.,Department of Cardiology Democritus University of Thrace, University General Hospital, Alexandroupolis, Greece
| | - Frederikus A Klok
- Center for Thrombosis and Haemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, Mainz, Germany.,Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Albinusdreef 2, RC, Leiden, the Netherlands
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Abstract
BACKGROUND Syncope represents a common condition among the general population. It is also a frequent complaint of patients in the emergency department (ED). Pulmonary embolism (PE) considers a differential diagnosis, particularly in a case of syncope without chest pain. STUDY QUESTION What is the prevalence of PE among patients who presented an episode of syncope to the ED and among those hospitalized for syncope in a tertiary care hospital? STUDY DESIGN From January 2012 to December 2017, we conducted a prospective observational study among adult patients presenting themselves to the ED consecutively or admitted for syncope. MEASURES AND OUTCOMES Syncope and PE were defined by professional guidelines. PE was ruled out in patients who had a low pretest clinical probability, as per Wells score and a negative D-dimer assay. In other patients, computed tomography pulmonary angiography was performed. RESULTS Seventeen thousand eight-two patients (mean age 71.3 ± 13.24 years) visited the ED for syncope. PE was detected in 45 patients (mean age 65.75 ± 9.45 years): 4 with low risk, 26 with intermediate risk, and 15 with high risk. The prevalence of PE in those hospitalized with syncope was 11.47%, which is 45 of 392 (confidence interval 95% 8.48-15.04), and was 2.52%, 45 of 1782 (confidence interval 95% 1.8-3.3), in patients presenting with syncope to the ED. The location of the embolus was bilateral in 24 patients (53.33%), in a main pulmonary artery in 10 (22.22%), in a lobar artery in 10 (22.22%), and in a segmental artery in 1 (2.22%). CONCLUSIONS The occurrence of syncope, if not explained otherwise, should alert one to consider PE as a differential diagnosis. PE rate, presenting as syncope, is the highest in patients with large thrombi, which is responsible for bilateral or proximal obstruction in a main or lobar pulmonary artery.
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Iqbal U, Jameel A, Anwar H, Scribani MB, Bischof E, Chaudhary A. Does Syncope Predict Mortality in Patients With Acute Pulmonary Embolism? A Retrospective Review. J Clin Med Res 2017; 9:516-519. [PMID: 28496553 PMCID: PMC5412526 DOI: 10.14740/jocmr3037w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 11/15/2022] Open
Abstract
Background Acute pulmonary embolism (APE) is a potentially fatal disease with high mortality. Prior studies have shown an increased frequency of central localization of the clot, right ventricular dysfunction and elevated troponin in patients who present with syncope and APE. Existing evidence regarding mortality and length of hospital stay in these patients is unclear. Methods We retrospectively reviewed electronic medical records of patients who were admitted in a tertiary care hospital in rural Upstate New York and diagnosed with APE from July 2014 to July 2016. Two hundred nineteen patients were reviewed in two groups: patients who presented with syncope and those without syncope. Results The prevalence of syncope was found to be 6.8% (15/219). Hypotension on admission was more common among patients with syncope compared to no syncope (26.7% and 7.4%, respectively, P = 0.03). A clinically significant difference was found in 30-day mortality among those with syncope versus no syncope (21.3% vs. 7.4%, P = 0.096). No significant difference was found in length of stay (mean 6.7 days in patients with syncope vs. 6.4 without syncope, P = 0.783), central localization (26.7% with syncope vs. 43.2% without syncope, P = 0.21) or troponin elevation (46.2% in patients with syncope vs. 27.9% without syncope, P = 0.205). On multivariable analysis, hypotension was significantly higher among those with syncope (odds ratio: 5.23, P = 0.0148). Conclusion This study suggests 30-day mortality may be higher among patients with syncope. It is important to risk stratify patients on admission in order to reduce mortality and morbidity associated with lethal disease.
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Affiliation(s)
- Umair Iqbal
- Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Ayesha Jameel
- Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Hafsa Anwar
- Dow University of Health and Sciences, Karachi, Pakistan
| | | | - Edward Bischof
- Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Ahmad Chaudhary
- Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
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Altınsoy B, Erboy F, Tanrıverdi H, Uygur F, Örnek T, Atalay F, Tor M. Syncope as a presentation of acute pulmonary embolism. Ther Clin Risk Manag 2016; 12:1023-8. [PMID: 27390523 PMCID: PMC4930221 DOI: 10.2147/tcrm.s105722] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Syncope is an atypical presentation for acute pulmonary embolism (APE). There are conflicting data concerning syncope and prognosis of APE. PATIENTS AND METHODS One hundred and seventy-nine consecutive patients aged 22-96 years (median, 68 years) with APE were retrospectively enrolled in the study. RESULTS Prevalence of syncope was 13% (n=23) at the time of presentation. Compared to patients without syncope, those with syncope had a higher rate of central embolism (83% vs 43%, respectively, P=0.002), right ventricular dysfunction (91% vs 68%, P=0.021), and troponin positivity (80% vs 39%, P=0.001) but not 30-day mortality (13% vs 10%, P=0.716). Multivariate analysis showed that central localization (odds ratio: 9.08) and cardiac troponin positivity (odds ratio: 4.67) were the independent correlates of the presence of syncope in the patients with APE. Frequency of cardiopulmonary disease was lower, and duration from symptom onset to hospital admission was shorter in patients with syncope (P=0.138 and 0.118, respectively), although not significant. CONCLUSION Syncope most likely represents an intermediate condition between massive APE and hypotension. In APE patients with syncope, the prognosis seems to depend on the underlying pathology, the patient's age, comorbidities and duration from symptom onset to hospital admission, and the use of thrombolytic therapy.
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Affiliation(s)
- Bülent Altınsoy
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak, Turkey
| | - Fatma Erboy
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak, Turkey
| | - Hakan Tanrıverdi
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak, Turkey
| | - Fırat Uygur
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak, Turkey
| | - Tacettin Örnek
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak, Turkey
| | - Figen Atalay
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak, Turkey
| | - Meltem Tor
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak, Turkey
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