Key result
Emergency department syncope is associated with ~9% all-cause mortality over nearly two years.
Why the study?
What are the early and late death rates and syncopal relapse rates in patients presenting to the emergency department with syncope managed according to ESC guidelines?
Observational (n=380)
Yes
What are the early and late death rates and syncopal relapse rates in patients presenting to the emergency department with syncope managed according to ESC guidelines?
Patients presenting to the ED with syncope face a peak of cardiovascular mortality in the first month, while late unfavorable outcomes are driven by associated cardiovascular diseases rather than the syncope mechanism itself.
Substantial risks persist in ESC-managed ED syncope; leaves open whether intensified early intervention improves outcomes.
AIMS: We evaluated the early (1 month) and late (2 years) death rate and syncopal relapses of patients referred for syncope to 11 general hospitals emergency departments. Patients were enrolled in the Evaluation of Guidelines in SYncope Study 2 (EGSYS 2) study. The guidelines of the European Society of Cardiology were strictly followed in the management of patients. METHODS AND RESULTS: Out of the 465 patients enrolled in the EGSYS 2 study, 398 (86%) underwent a complete follow-up. We excluded 18 patients with non-syncopal attacks. Among the remaining 380 patients, death of any cause occurred in 35 (9.2%). The mean follow-up was 614 +/- 73 days. Six deaths (17% of total) occurred during the first month of follow-up. Patients who died were older, had a higher incidence of structural heart disease and/or abnormal ECG, had injuries related to syncope and higher EGSYS score. Syncope recurred in 63 (16.5%) patients. Syncopal relapses occurred in only one patient during the first month of follow-up. The incidence of syncopal recurrences was unrelated to the mechanism of syncope. No clinical differences were found between patients with or without syncopal recurrence and in patients with EGSYS score < or >or=3. CONCLUSION: A peak of cardiovascular mortality but not of syncopal recurrences was observed in patients attending to the emergency department for syncope within the first month. Late unfavourable outcomes were caused by associated cardiovascular diseases rather than by the mechanism of syncope. The causes of syncope did not determine the recurrence rate.
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Ungar et al. (2010) conducted an observational in Syncope (n=380). Syncope was evaluated on Early (1 month) and late (2 years) death rate and syncopal relapses. Among patients presenting to the emergency department with syncope, all-cause mortality was 9.2% and syncope recurrence was 16.5% over a mean follow-up of 614 days.
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