Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope.

BACKGROUND The prevalence of pulmonary embolism among patients hospitalized for syncope is not well documented, and current guidelines pay little attention to a diagnostic workup for pulmonary embolism in these patients. METHODS We performed a systematic workup for pulmonary embolism in patients admitted to 11 hospitals in Italy for a first episode of syncope, regardless of whether there were alternative explanations for the syncope. The diagnosis of pulmonary embolism was ruled out in patients who had a low pretest clinical probability, which was defined according to the Wells score, in combination with a negative d-dimer assay. In all other patients, computed tomographic pulmonary angiography or ventilation-perfusion lung scanning was performed. RESULTS A total of 560 patients (mean age, 76 years) were included in the study. A diagnosis of pulmonary embolism was ruled out in 330 of the 560 patients (58.9%) on the basis of the combination of a low pretest clinical probability of pulmonary embolism and negative d-dimer assay. Among the remaining 230 patients, pulmonary embolism was identified in 97 (42.2%). In the entire cohort, the prevalence of pulmonary embolism was 17.3% (95% confidence interval, 14.2 to 20.5). Evidence of an embolus in a main pulmonary or lobar artery or evidence of perfusion defects larger than 25% of the total area of both lungs was found in 61 patients. Pulmonary embolism was identified in 45 of the 355 patients (12.7%) who had an alternative explanation for syncope and in 52 of the 205 patients (25.4%) who did not. CONCLUSIONS Pulmonary embolism was identified in nearly one of every six patients hospitalized for a first episode of syncope. (Funded by the University of Padua; PESIT ClinicalTrials.gov number, NCT01797289 .).

[1]  W. Dippold,et al.  Syncope and collapse in acute pulmonary embolism. , 2016, The American journal of emergency medicine.

[2]  M. Alemzadeh-Ansari,et al.  Correlates of Syncope in Patients With Acute Pulmonary Thromboembolism , 2015, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[3]  M. Saravi,et al.  Etiology of syncope in hospitalized patients , 2015, Caspian journal of internal medicine.

[4]  Adam Torbicki,et al.  Management of venous thrombo-embolism: an update. , 2014, European heart journal.

[5]  D. Benditt,et al.  Syncope: classification and risk stratification. , 2014, Journal of cardiology.

[6]  Jeroen J. Bax,et al.  ESC Guidelines on the diagnosis and management of acute pulmonary embolism , 2014 .

[7]  F. García-Bragado Dalmau [Oral Rivaroxaban for the treatment of symptomatic pulmonary embolism]. , 2013, Revista clinica espanola.

[8]  G. Raskob,et al.  Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. , 2012, The New England journal of medicine.

[9]  Elie A Akl,et al.  Prevention of VTE in Nonsurgical Patients Antithrombotic Therapy and Prevention of Thrombosis , 9 th ed : American College of Chest Physicians Evidence-Based Clinical Practice Guidelines , 2013 .

[10]  P. Vanbrabant,et al.  DIAGNOSTIC YIELD OF SYNCOPE INVESTIGATION (INITIATED) IN THE EMERGENCY DEPARTMENT: A PILOT STUDY , 2010, Acta clinica Belgica.

[11]  J. Svendsen,et al.  A nationwide, retrospective analysis of symptoms, comorbidities, medical care and autopsy findings in cases of fatal pulmonary embolism in younger patients , 2010, Journal of thrombosis and haemostasis : JTH.

[12]  J. Blanc,et al.  Guidelines for the diagnosis and management of syncope (version 2009). , 2009, European heart journal.

[13]  M. Brignole,et al.  Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score , 2008, Heart.

[14]  G. Guyatt,et al.  Physicians Evidence-Based Clinical Practice Development : American College of Chest Thrombolytic Therapy Guideline Methodology for Antithrombotic and , 2008 .

[15]  S. Ederhy Idraparinux versus standard therapy for venous thromboembolic disease. , 2007 .

[16]  H. Sostman,et al.  Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. , 2006, The American journal of medicine.

[17]  J. Douketis,et al.  An Evaluation of d-Dimer in the Diagnosis of Pulmonary Embolism , 2006, Annals of Internal Medicine.

[18]  Pieter W Kamphuisen,et al.  Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. , 2006, JAMA.

[19]  M. Prins,et al.  Management studies using a combination of D‐dimer test result and clinical probability to rule out venous thromboembolism: a systematic review , 2005, Journal of thrombosis and haemostasis : JTH.

[20]  F. Guinet,et al.  Comparison of perfusion lung scanning and angiography in the estimation of vascular obstruction in acute pulmonary embolism , 2004, European Journal of Nuclear Medicine.

[21]  G. Pantaleo,et al.  Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope , 2003, Vascular medicine.

[22]  H. Büller,et al.  Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study , 2003, Thrombosis and Haemostasis.

[23]  H. Büller,et al.  Use of a clinical decision rule in combination with D-dimer concentration in diagnostic workup of patients with suspected pulmonary embolism: a prospective management study. , 2002, Archives of internal medicine.

[24]  J. Blanc,et al.  Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. , 2002, European heart journal.

[25]  D. Levy,et al.  Incidence and prognosis of syncope. , 2002, The New England journal of medicine.

[26]  Christian Lovis,et al.  Prospective evaluation of patients with syncope: a population-based study. , 2001, The American journal of medicine.

[27]  M Gent,et al.  Derivation of a Simple Clinical Model to Categorize Patients Probability of Pulmonary Embolism: Increasing the Models Utility with the SimpliRED D-dimer , 2000, Thrombosis and Haemostasis.

[28]  T. Wachtel,et al.  Pulmonary embolism presenting as syncope: case report and review of the literature. , 1999, Heart & lung : the journal of critical care.

[29]  J. R. Foster,et al.  Vagal syncope during recurrent pulmonary embolism. , 1983, JAMA.

[30]  J. Alpert,et al.  Syncope in patients with pulmonary embolism. , 1977, JAMA.