Key result
Presenting syncope in acute PE does not independently predict in-hospital mortality despite associated hemodynamic instability.
Why the study?
Whether syncope as a presenting symptom independently classifies acute pulmonary embolism into a high mortality risk group remains controversial.
Does syncope at presentation independently predict in-hospital mortality in patients with acute pulmonary embolism?
Cohort (n=76)
No
Does syncope at presentation independently predict in-hospital mortality in patients with acute pulmonary embolism?
Syncope in acute pulmonary embolism is associated with higher mortality due to its link with hemodynamic instability, but it is not an independent predictor of mortality.
Answers are grounded in this paper and cite their sources.
Syncope in APE may signal need for closer hemodynamic monitoring; retrospective data leave open its independent prognostic value.
Whether syncope as a presenting symptom independently classifies acute pulmonary embolism (APE) into a high mortality risk group remains a matter of controversy. We retrospectively included all consecutive patients admitted to our clinic with APE from January 2014 to December 2016. Our sample consisted of 76 patients with a mean age of 69 ±13.6 years, 64.5% female. 14.3% presented with syncope at admission. In-hospital mortality was 20.8%. Patients with syncope were more likely to require inotropic support (OR = 5.2, 95 % 1.17-23.70, p=0.03) due to the association of cardiogenic shock (OR= 15.95% CI 3.02-74.32, p < 0.001) and systolic blood pressure below 90 mmHg (OR=5.52, 95% CI 1.24-24.47, p=0.03). Patients with syncope had a higher PESI score (150.9 ± 51.1 vs 99.9 ± 30.1, p < 0.001) and a greater in-hospital mortality (OR= 4.5, 95% CI 1.14-17.62, p=0.03). However, multivariate logistic regression equations did not identify syncope as an independent predictor of mortality. In our sample, syncope did not independently reclassify the patient in a higher mortality group, but due to the association with hemodynamic instability, which remains the primary tool in therapeutic decision-making.
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Ploesteanu et al. (2019) conducted a cohort in Acute pulmonary embolism (n=76). Syncope at presentation vs. Without syncope at presentation was evaluated on In-hospital mortality (independent predictor via multivariate analysis) (HR 0.68, 95% CI 0.092-5.115, p=0.714). Although associated with hemodynamic instability, syncope at presentation was not an independent predictor of in-hospital mortality in patients with acute pulmonary embolism (HR 0.68).
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