Highlights
- •The clinical implications of syncope in patients with pulmonary embolism are suggested.
- •Syncope was associated with a more severe form of pulmonary embolism.
- •Syncope did not influence the short-term prognosis of pulmonary embolism.
- •Central emboli and blood troponin I level were independent factors of syncope.
- •Unprovoked pulmonary embolism and female sex were also associated with syncope.
Abstract
Background
Syncope is an unusual clinical manifestation of pulmonary embolism (PE), and the clinical
significance of syncope in PE patients remains controversial. We investigated the
incidence of syncope, examined the clinical factors associated with syncope, and assessed
the association between syncope and the short-term outcomes of PE.
Methods
We retrospectively classified patients presenting with PE into 2 groups: patients
with syncope and those without syncope. We compared the clinical and computed tomography
parameters between the groups.
Results
Among 1084 patients diagnosed with PE, 45 (4.2%) presented with syncope. Four patients
which presented with cardiac arrest were excluded from the study. The syncope group
showed significantly higher blood biomarker levels and higher rates of central PE
and right ventricular dilation than the control group. Unprovoked PE (odds ratio [OR]
8.046, 95% confidence interval [CI] 3.073–21.069, p < 0.001), female sex (OR 3.419,
95% CI 1.348–8.675, p = 0.010), central PE (OR 2.854, 95% CI 1.298–6.278, p = 0.009),
and troponin I level (OR 2.812, 95% CI 1.765–4.480, p < 0.001) were observed to be
independent factors associated with syncope in PE patients. However, multivariate
analysis showed that the presence of syncope was not a significant predictor of adverse
outcomes and recurrent venous thromboembolism in PE patients.
Conclusions
Although syncope is associated with a more severe form of PE, it does not influence
the short-term prognosis of PE. Central PE, blood troponin I level, unprovoked PE,
and female sex were observed to be clinical factors related with syncope in patients
with PE.
Keywords
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Article info
Publication history
Published online: February 27, 2018
Accepted:
February 26,
2018
Received in revised form:
February 19,
2018
Received:
October 27,
2017
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
