Syncope and In-Hospital Mortality in Pulmonary Embolism: Insights from 300 Patients

Background: Pulmonary embolism (PE) is a major cause of cardiovascular mortality, with heterogeneous presentation. Syncope, reported in 10–20% of cases, may indicate severe hemodynamic compromise, but its independent prognostic role remains uncertain. Methods: We retrospectively analyzed 300 patients admitted with acute PE confirmed by computed tomography pulmonary angiography between January 2022 and December 2024. Patients were stratified according to the presence of syncope at admission. Clinical, laboratory, and echocardiographic findings and outcomes were compared. Logistic regression was used to identify independent predictors of in-hospital mortality. The present study is a single-center, retrospective analysis. Results: Syncope occurred in 48 patients (16%). Compared with those without syncope, these patients had higher rates of right ventricular dysfunction (68.7% vs. 32.5%, p = 0.002), elevated troponin (75% vs. 44%, p = 0.01), hypotension (29% vs. 8%, p < 0.001), Intensive Care Unit (ICU) admission (56% vs. 22%, p < 0.001), and thrombolysis (19% vs. 8%, p = 0.03). In-hospital mortality was markedly higher in the syncope group (37.5% vs. 7.1%, p < 0.001). Multivariate analysis confirmed syncope as an independent predictor of mortality (OR 4.2, 95% CI 2.1–8.4, p < 0.001), alongside right ventricular dysfunction and elevated troponin. Conclusions: Syncope at presentation is a simple but powerful clinical marker of high-risk PE and should prompt intensive monitoring and consideration of early reperfusion therapy.