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Pulmonary Embolism Among Patients With Syncope
Study Questions:
What is the prevalence of pulmonary embolism in patients who are hospitalized for a first episode of syncope?
Methods:
The investigators performed a systematic workup for pulmonary embolism in patients admitted to 11 hospitals in Italy for a first episode of syncope, regardless of whether there were alternative explanations for the syncope. The diagnosis of pulmonary embolism was ruled out in patients who had a low pretest clinical probability, which was defined according to the Wells score, in combination with a negative D-dimer assay. In all other patients, computed tomographic pulmonary angiography or ventilation–perfusion lung scanning was performed. Odds ratios with 95% confidence intervals were calculated with the use of logistic regression.
Results:
A total of 560 patients (mean age, 76 years) were included in the study. A diagnosis of pulmonary embolism was ruled out in 330 of the 560 patients (58.9%) on the basis of the combination of a low pretest clinical probability of pulmonary embolism and negative D-dimer assay. Among the remaining 230 patients, pulmonary embolism was identified in 97 (42.2%). In the entire cohort, the prevalence of pulmonary embolism was 17.3% (95% confidence interval, 14.2-20.5). Evidence of an embolus in a main pulmonary or lobar artery or evidence of perfusion defects larger than 25% of the total area of both lungs was found in 61 patients. Pulmonary embolism was identified in 45 of the 355 patients (12.7%) who had an alternative explanation for syncope and in 52 of the 205 patients (25.4%) who did not.
Conclusions:
The authors concluded that pulmonary embolism was identified in nearly one of every six patients hospitalized for a first episode of syncope.
Perspective:
This study reports that in a large series of patients who were hospitalized for a first episode of syncope, a high prevalence of pulmonary embolism was found with pulmonary embolism confirmed in approximately one of every six patients. Furthermore, the rate of pulmonary embolism was highest among those who did not have an alternative explanation for syncope. Patients with multiple episodes of syncope were excluded from this study, and these study results are not applicable to such patients. Given the high prevalence of pulmonary embolism among patients who were hospitalized for a first episode of syncope, it seems reasonable to assess patients for pulmonary embolism presenting with a first episode of syncope.
Keywords: Angiography, Diagnostic Imaging, Fibrin Fibrinogen Degradation Products, Prevalence, Pulmonary Embolism, Syncope, Tomography, X-Ray Computed, Vascular Diseases
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