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. 2017 Jun;25(6):376-387.
doi: 10.1007/s12471-017-0970-7.

Presence and extent of cardiac computed tomography angiography defined coronary artery disease in patients presenting with syncope

S Altintas  1 , T Dinh  1 , N G H M Marcks  1   2 , M Kok  2   3 , A J J Aerts  4 , B Weijs  1 , Y Blaauw  5 , J E Wildberger  2   3 , M Das  2   3 , B L J H Kietselaer  1   2   3 , H J G M Crijns  6   7
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Presence and extent of cardiac computed tomography angiography defined coronary artery disease in patients presenting with syncope

S Altintas et al. Neth Heart J. 2017 Jun.

Abstract

Background: In syncope patients, presence of coronary artery disease (CAD) is associated with poor prognosis. However, data concerning CAD prevalence in syncope patients without known cardiovascular disease are lacking. Therefore, the aim of this study was to investigate presence and extent of CAD in syncope patients.

Methods: We included 142 consecutive patients presenting with syncope at the outpatient cardiology clinic who underwent coronary computed tomography (CT) angiography. Syncope type was ascertained by two reviewers, blinded for coronary CT angiography results. Of the patients, 49 had cardiac syncope (arrhythmia or structural cardiopulmonary disease) and 93 had non-cardiac syncope (reflex [neurally-mediated], orthostatic or of unknown cause). Cardiac syncope patients were compared with matched stable chest pain patients regarding age, gender, smoking status, diabetes mellitus type 2 and systolic blood pressure.

Results: Distribution of CAD presence and extent in cardiac and non-cardiac syncope patients was as follows: 72% versus 48% any CAD; 31% versus 26% mild, 8% versus 14% moderate and 33% versus 7% severe CAD. Compared with non-cardiac syncope, patients with cardiac syncope had a significantly higher CAD presence and extent (p = 0.001). Coronary calcium score, segment involvement and stenosis score were also higher in cardiac syncope patients (p-values ≤0.004). Compared to the chest pain control group, patients with cardiac syncope showed a higher, however, non-significant, prevalence of any CAD (72% versus 63%) and severe CAD (33% versus 19%).

Conclusion: Patients with cardiac syncope show a high presence and extent of CAD in contrast to non-cardiac syncope patients. These results suggest that CAD may play an important role in the occurrence of cardiac syncope.

Keywords: Cardiogenic syncope; Coronary artery disease; Multidetector computed tomography.

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Conflict of interest statement

S. Altintas, T. Dinh, N.G.H.M. Marcks, M. Kok, A.J.J. Aerts, B. Weijs, Y. Blaauw, J.E. Wildberger, M. Das, B.L.J.H. Kietselaer and H.J.G.M. Crijns declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CAD presence and extent (percentages) within cardiac syncope patients versus non-cardiac syncope patients
Fig. 2
Fig. 2
CAD presence and extent (percentages) within cardiac syncope versus matched chest pain control group
See this image and copyright information in PMC

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