Abstract
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.
Highlights
Acute pulmonary embolism (APE) is a condition with a high fatality rate mainly due to the variability of onset symptoms that can delay diagnosis, ranking third as one of the most frequently occurring cardiovascular diseases with an overall annual incidence of 100–200 per 100.000 inhabitants [1].Syncope represents the onset symptom in 9 to 35% of patients [2,3,4,5,6]
Our study group consisted of 76 patients with a mean age of 69 ± 13.6 years. 14.3% presented with syncope on admission to the hospital
A growing body of evidence led to the assumption that the presentation of APE with syncope is associated with poorer outcome, regardless of the presence of hemodynamic instability [4,19]
Summary
Syncope represents the onset symptom in 9 to 35% of patients [2,3,4,5,6]. Whether this symptom will better help the attending physician to classify the patient into a higher risk group or not, remains a matter of controversy as currently available data does not show a significant correlation with mortality [7,8,9]. APE mortality rate varies between 1% and 60%, depending on the clinical presentation and the severity of right ventricular dysfunction [10,11]. The risk stratification strategy is primarily based on clinical features and secondarily on right ventricular myocardial dysfunction and/or myocardial injury [10]
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