Multicenter Study

. 2019 Aug 13;74(6):744-754.

doi: 10.1016/j.jacc.2019.06.020.

Prevalence of Pulmonary Embolism in Patients With Syncope

Patrick Badertscher¹, Jeanne du Fay de Lavallaz², Angelika Hammerer-Lercher³, Thomas Nestelberger⁴, Tobias Zimmermann⁴, Marc Geiger⁴, Orell Imahorn⁴, Òscar Miró⁵, Emilio Salgado⁵, Michael Christ⁶, Louise Cullen⁷, Martin Than⁸, F Javier Martin-Sanchez⁹, Salvatore Di Somma¹⁰, W Frank Peacock¹¹, Dagmar I Keller¹², Juan Pablo Costabel¹³, Joan Walter⁴, Jasper Boeddinghaus⁴, Raphael Twerenbold⁴, Adriana Méndez³, Boris Gospodinov³, Christian Puelacher¹⁴, Desiree Wussler⁴, Luca Koechlin¹⁵, Damian Kawecki¹⁶, Nicolas Geigy¹⁷, Ivo Strebel⁴, Jens Lohrmann¹⁸, Michael Kühne¹⁸, Tobias Reichlin¹⁹, Christian Mueller²⁰; BASEL IX Investigators

Collaborators, Affiliations

Affiliations

¹ 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.
² Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy. Electronic address: https://twitter.com/JDFDLz.
³ Department of Laboratory Medicine, Kantonsspital Aarau, Switzerland.
⁴ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.
⁵ GREAT network, Rome, Italy; Hospital Clinic, Barcelona, Catalonia, Spain.
⁶ General Hospital, Paracelsus Medical University, Nürnberg, Germany.
⁷ GREAT network, Rome, Italy; Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.
⁸ GREAT network, Rome, Italy; Christchurch Hospital, Christchurch, New Zealand.
⁹ GREAT network, Rome, Italy; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain.
¹⁰ GREAT network, Rome, Italy; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy.
¹¹ GREAT network, Rome, Italy; Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
¹² University Hospital Zürich, Zürich, Switzerland.
¹³ Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
¹⁴ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁵ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁶ GREAT network, Rome, Italy; 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.
¹⁷ Emergency Department, Kantonsspital Liestal, Liestal, Switzerland.
¹⁸ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁹ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Cardiology, Inselspital Bern, Bern, Switzerland.
²⁰ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy. Electronic address: christian.mueller@usb.ch.

PMID: 31395124
DOI: 10.1016/j.jacc.2019.06.020

Free article

Multicenter Study

Prevalence of Pulmonary Embolism in Patients With Syncope

Patrick Badertscher et al. J Am Coll Cardiol. 2019.

Free article

. 2019 Aug 13;74(6):744-754.

doi: 10.1016/j.jacc.2019.06.020.

Authors

Affiliations

¹ 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.
² Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy. Electronic address: https://twitter.com/JDFDLz.
³ Department of Laboratory Medicine, Kantonsspital Aarau, Switzerland.
⁴ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.
⁵ GREAT network, Rome, Italy; Hospital Clinic, Barcelona, Catalonia, Spain.
⁶ General Hospital, Paracelsus Medical University, Nürnberg, Germany.
⁷ GREAT network, Rome, Italy; Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.
⁸ GREAT network, Rome, Italy; Christchurch Hospital, Christchurch, New Zealand.
⁹ GREAT network, Rome, Italy; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain.
¹⁰ GREAT network, Rome, Italy; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy.
¹¹ GREAT network, Rome, Italy; Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
¹² University Hospital Zürich, Zürich, Switzerland.
¹³ Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
¹⁴ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁵ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁶ GREAT network, Rome, Italy; 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.
¹⁷ Emergency Department, Kantonsspital Liestal, Liestal, Switzerland.
¹⁸ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁹ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Cardiology, Inselspital Bern, Bern, Switzerland.
²⁰ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy. Electronic address: christian.mueller@usb.ch.

PMID: 31395124
DOI: 10.1016/j.jacc.2019.06.020

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).

Keywords: diagnostic testing; pulmonary embolism; syncope.

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Comment in

Pulmonary Embolism in Patients With Syncope: Horse or Zebra?
Goldhaber SZ. Goldhaber SZ. J Am Coll Cardiol. 2019 Aug 13;74(6):755-758. doi: 10.1016/j.jacc.2019.04.070. J Am Coll Cardiol. 2019. PMID: 31395125 No abstract available.
On the True Prevalence of Pulmonary Embolism in Patients Hospitalized for a First Syncopal Event.
Prandoni P, Lensing AWA, Prins MH, Barbar S. Prandoni P, et al. J Am Coll Cardiol. 2019 Dec 10;74(23):2950-2951. doi: 10.1016/j.jacc.2019.08.1069. J Am Coll Cardiol. 2019. PMID: 31806140 No abstract available.

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Prevalence of Pulmonary Embolism in Patients With Syncope

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Prevalence of Pulmonary Embolism in Patients With Syncope

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