Beyond Cardiac Syncope: Evaluating the Effectiveness of EGSYS in Predicting Reflex Syncope

Abstract Introduction Syncope is a common clinical condition with significant impact on patient quality of life (QoL) and healthcare utilization. Cardiac syncope (CS) is associated with higher morbidity due to underlying heart conditions, while non-cardiac syncope (NCS), particularly reflex syncope (RS), is more frequent but resulting in injuries and QoL impairment. Differentiating between CS and RS is essential for appropriate management and risk assessment. The Evaluation of Guidelines in Syncope Study (EGSYS) score was designed to predict the likelihood of CS, providing clinicians with a tool for risk stratification. However, its accuracy in predicting RS is less understood. This study aims to assess the effectiveness of the EGSYS score in identifying patients with a higher likelihood of RS, focusing on its role as a non-invasive predictor in a clinical setting. Methods We conducted a retrospective review of patients who underwent tilt testing (TT) for recurrent syncope at our department over a 12-month period. The EGSYS score was calculated based on clinical history. Patients were then divided into two groups: those with EGSYS scores 3 (indicating a lower likelihood of CS) and those with scores of 3. TT results were used to assess RS. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the EGSYS score in predicting RS were calculated. Results Of the 184 patients (age 57.0 ± 15.0 years; 62.5% female), 84 (45.7%) had a positive TT result, suggesting vulnerability to RS in the absence of cardiac causes. The EGSYS score was ≥3 in 48 patients (26.1%) and 3 in 125 patients (67.9%). For predicting RS, an EGSYS score 3 demonstrated a sensitivity of 41%, a specificity of 53%, a PPV of 25%, and a NPV of 70%. Conclusion These findings indicate that the accuracy of an EGSYS score 3 in differentiating between RS and other etiologies remains limited. The low sensitivity and specificity observed suggest that the score should not be used as a standalone tool for this purpose. Nonetheless, its relatively high NPV suggests potential utility in excluding high-risk cardiac cases from further investigation. This study underscores the need for more targeted tools to improve risk stratification and optimize management for those with suspected RS.