Soteriades Elpidoforos S, Evans Jane C, Larson Martin G, Chen Ming Hui, Chen Leway, Benjamin Emelia J, Levy Daniel
National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, Mass 01702-5827, USA.
N Engl J Med. 2002 Sep 19;347(12):878-85. doi: 10.1056/NEJMoa012407.
Little is known about the epidemiology and prognosis of syncope in the general population.
We evaluated the incidence, specific causes, and prognosis of syncope among women and men participating in the Framingham Heart Study from 1971 to 1998.
Of 7814 study participants followed for an average of 17 years, 822 reported syncope. The incidence of a first report of syncope was 6.2 per 1000 person-years. The most frequently identified causes were vasovagal (21.2 percent), cardiac (9.5 percent), and orthostatic (9.4 percent); for 36.6 percent the cause was unknown. The multivariable-adjusted hazard ratios among participants with syncope from any cause, as compared with those who did not have syncope, were 1.31 (95 percent confidence interval, 1.14 to 1.51) for death from any cause, 1.27 (95 percent confidence interval, 0.99 to 1.64) for myocardial infarction or death from coronary heart disease, and 1.06 (95 percent confidence interval, 0.77 to 1.45) for fatal or nonfatal stroke. The corresponding hazard ratios among participants with cardiac syncope were 2.01 (95 percent confidence interval, 1.48 to 2.73), 2.66 (95 percent confidence interval, 1.69 to 4.19), and 2.01 (95 percent confidence interval, 1.06 to 3.80). Participants with syncope of unknown cause and those with neurologic syncope had increased risks of death from any cause, with multivariable-adjusted hazard ratios of 1.32 (95 percent confidence interval, 1.09 to 1.60) and 1.54 (95 percent confidence interval, 1.12 to 2.12), respectively. There was no increased risk of cardiovascular morbidity or mortality associated with vasovagal (including orthostatic and medication-related) syncope.
Persons with cardiac syncope are at increased risk for death from any cause and cardiovascular events, and persons with syncope of unknown cause are at increased risk for death from any cause. Vasovagal syncope appears to have a benign prognosis.
关于普通人群中晕厥的流行病学和预后情况，人们了解甚少。
我们评估了1971年至1998年参与弗雷明汉心脏研究的男性和女性中晕厥的发病率、具体病因及预后。
在平均随访17年的7814名研究参与者中，有822人报告发生过晕厥。首次报告晕厥的发病率为每1000人年6.2例。最常见的病因是血管迷走性（21.2%）、心脏性（9.5%）和体位性（9.4%）；36.6%的病因不明。与未发生晕厥的参与者相比，任何原因导致晕厥的参与者中，全因死亡的多变量调整风险比为1.31（95%置信区间为1.14至1.51），心肌梗死或冠心病死亡的风险比为1.27（95%置信区间为0.99至1.64），致命或非致命性卒中的风险比为1.06（95%置信区间为0.77至1.45）。心脏性晕厥参与者的相应风险比分别为2.01（95%置信区间为1.48至2.73）、2.66（95%置信区间为1.69至4.19）和2.01（95%置信区间为1.06至3.80）。病因不明的晕厥参与者和神经源性晕厥参与者全因死亡风险增加，多变量调整风险比分别为1.32（95%置信区间为1.09至1.60）和1.54（95%置信区间为1.12至2.12）。血管迷走性（包括体位性和药物相关性）晕厥与心血管发病率或死亡率增加无关。
心脏性晕厥患者全因死亡和心血管事件风险增加，病因不明的晕厥患者全因死亡风险增加。血管迷走性晕厥似乎预后良好。
