Pulmonary Embolism Is Common Among Patients with Syncope

Pulmonary embolism is more common than previous thought in patients with syncope, according to new research from Italy.

Although pulmonary embolism is considered a differential diagnosis of syncope, it is rarely considered as a possible cause. Therefore, the researchers conducted their study to examine the prevalence of pulmonary embolism among patients hospitalized for syncope.
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The researchers assessed patients aged 18 years and older who were admitted to 11 hospitals in Italy for a first episode of syncope.

They defined syncope as a transient loss of consciousness with rapid onset, short duration (<1 min), and spontaneous resolution (with obvious causes ruled out).

A diagnosis of pulmonary embolism was ruled out in patients who had a low pretest clinical probability with a negative D-dimer assay.

Of the 560 patients included in the study, 330 (58.9%) a diagnosis of pulmonary embolism was ruled out. Among the remaining 230 patients, 97 (42.2%) had pulmonary embolism. Overall, the prevalence of pulmonary embolism among all the study participants was 17.3%.

In addition, 45 of the 355 patients (12.7%) who had an alternative explanation for the syncope and 52 of the 205 (25.4%) who did not were diagnosed with pulmonary embolism.

“Among patients who were hospitalized for a first episode of syncope and who were not receiving anticoagulation therapy, pulmonary embolism was confirmed in 17.3% (approximately one of every six patients),” the researchers concluded. “The rate of pulmonary embolism was highest among those who did not have an alternative explanation for syncope.”

—Amanda Balbi

Reference:

Prandoni P, Lensing AWA, Prins MH, et al; Pulmonary Embolism in Syncope Italian Trial (PESIT) investigators. Prevalence of pulmonary embolism among patients hospitalized for syncope [published online October 20, 2016]. N Engl J Med. doi:10.1056/NEJMoa1602172.