Department of Cardiology, Rovigo General Hospital, Rovigo, Italy.
Department of Cardiology, Rovigo General Hospital, Rovigo, Italy; Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy.
Eur J Intern Med. 2018 Aug;54:27-33. doi: 10.1016/j.ejim.2018.04.004. Epub 2018 Apr 11.
Syncope and pre-syncope are well-known symptoms of acute pulmonary embolism (PE). However, data about their impact on short-term mortality are scant. We assess the short-term mortality (30-day) for all-causes in PE patients admitted with syncope or with pre-syncope, according their hemodynamic status at admission.
Patients from the prospective Italian Pulmonary Embolism Registry (IPER) were included in the study. At admission, subjects were stratified according to 2008 ESC guidelines (as high- and non-high-risk patients).
Among the 1716 patients with confirmed acute PE, syncope or pre-syncope was the initial manifestation of the disease in 458 (26.6%) patients. Short-term mortality (30-day) for all causes were significantly higher in patients with syncope/presyncope (42.5% vs 6.2%, p < 0.0001) while PE patients with presyncope demonstrated a worst short-term outcome, in terms of mortality for all-causes, when compared to those subjects with syncope at admission (47.2% vs 37.4%, p = 0.03). A statistically significant difference in survival between pre-syncope and syncope was observed only in hemodynamically unstable patients [log rank p = 0.036]. Cox regression analysis confirmed that pre-syncope resulted an independent predictor of 30-day mortality in hemodynamically unstable patients at admission (HR 2.13, 95% CI 1.08-4.22, p = 0.029), independently from right ventricular dysfunction (RVD) (HR 6.23, 95% CI 3.05-12.71, p < 0.0001), age (HR 1.03, 95% CI 1.00-1.06, p = 0.023) and thrombolysis (HR 2.27, 95% CI 1.11-4.66, p = 0.025).
PE patients with syncope/presyncope had a higher 30-day mortality for all-causes as well as patients with presyncope had a worst short-term outcome when compared to PE patients with syncope. Moreover, hemodynamically unstable patients with presyncope had a worst prognosis independently from the presence of RVD, age, positive cTn and thrombolytic treatment.
晕厥和先兆晕厥是急性肺栓塞（PE）的常见症状。然而，关于其对短期死亡率影响的数据很少。我们根据入院时的血流动力学状态评估所有因晕厥或先兆晕厥而入院的 PE 患者的短期（30 天）全因死亡率。
前瞻性意大利肺栓塞登记处（IPER）的患者纳入研究。入院时，根据 2008 年 ESC 指南（高危和非高危患者）对患者进行分层。
在 1716 例确诊的急性 PE 患者中，458 例（26.6%）患者以晕厥或先兆晕厥为首发症状。晕厥/先兆晕厥患者的短期（30 天）全因死亡率明显更高（42.5%比 6.2%，p<0.0001），而入院时先兆晕厥患者的短期全因死亡率预后最差（47.2%比 37.4%，p=0.03）。仅在血流动力学不稳定的患者中观察到晕厥和先兆晕厥之间的生存差异有统计学意义[对数秩检验，p=0.036]。Cox 回归分析证实，入院时血流动力学不稳定的患者，与右心室功能障碍（RVD）（HR 6.23，95%CI 3.05-12.71，p<0.0001）无关，与年龄（HR 1.03，95%CI 1.00-1.06，p=0.023）和溶栓治疗（HR 2.27，95%CI 1.11-4.66，p=0.025）独立相关。
晕厥/先兆晕厥的 PE 患者全因死亡率更高，与晕厥的 PE 患者相比，先兆晕厥的患者短期预后更差。此外，与 RVD、年龄、cTn 阳性和溶栓治疗无关，血流动力学不稳定且有先兆晕厥的患者预后最差。
