晕厥患者中的肺栓塞患病率。

Prevalence of Pulmonary Embolism in Patients With Syncope.

机构信息

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Cardiology, University of Illinois at Chicago, Chicago, Illinois. Electronic address: https://twitter.com/BadertscherPat.

出版信息

J Am Coll Cardiol. 2019 Aug 13;74(6):744-754. doi: 10.1016/j.jacc.2019.06.020.

DOI:10.1016/j.jacc.2019.06.020

PMID:31395124

Abstract

BACKGROUND

The prevalence of pulmonary embolism (PE) in patients presenting with syncope to the emergency department (ED) is largely unknown. This information, however, is necessary to balance the potential medical benefit or harm of systematic PE screening in patients presenting with syncope to the ED.

OBJECTIVES

This study sought to determine the prevalence of PE in patients with syncope.

METHODS

Unselected patients presenting with syncope to the ED were prospectively enrolled in a diagnostic multicenter study. Pre-test clinical probability for PE was assessed using the 2-level Wells score and the results of D-dimer testing using age-adapted cutoffs. Presence of PE was evaluated by imaging modalities, when ordered as part of the clinical assessment by the treating ED physician or by long-term follow-up data.

RESULTS

Long-term follow-up was complete in 1,380 patients (99%) at 360 days and 1,156 patients (83%) at 720 days. Among 1,397 patients presenting with syncope to the ED, PE was detected at presentation in 19 patients (1.4%; 95% confidence interval [CI]: 0.87% to 2.11%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.5% to 1.5%). In the subgroup of patients hospitalized (47%), PE was detected at presentation in 15 patients (2.3%; 95% CI: 1.4% to 3.7%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.4% to 2.0%).

CONCLUSIONS

PE seems to be a rather uncommon cause of syncope among patients presenting to the ED. Therefore, systematic PE-screening in all patients with syncope does not seem warranted. (BAsel Syncope EvaLuation Study [BASEL IX]; NCT01548352).

摘要

背景

在因晕厥而到急诊科（ED）就诊的患者中，肺栓塞（PE）的患病率尚不清楚。然而，为了权衡 ED 晕厥患者中系统的 PE 筛查可能带来的医疗获益或危害，该信息是必要的。

目的

本研究旨在确定晕厥患者中 PE 的患病率。

方法

本前瞻性诊断多中心研究纳入了因晕厥而到 ED 就诊的未筛选患者。使用 2 级 Wells 评分评估 PE 的预先测试临床可能性，并使用年龄适应的截断值评估 D-二聚体检测结果。通过影像学检查评估 PE 的存在，这些影像学检查是作为 ED 医生临床评估的一部分或通过长期随访数据进行的。

结果

在 360 天和 720 天，1380 例（99%）患者和 1156 例（83%）患者完成了长期随访。在因晕厥而到 ED 就诊的 1397 例患者中，19 例（1.4%；95%置信区间[CI]：0.87%至 2.11%）在就诊时即发现 PE。2 年随访期间新发 PE 或心血管死亡的发生率为 0.9%（95%CI：0.5%至 1.5%）。在住院患者（47%）亚组中，15 例（2.3%；95%CI：1.4%至 3.7%）在就诊时发现 PE。2 年随访期间新发 PE 或心血管死亡的发生率为 0.9%（95%CI：0.4%至 2.0%）。