Syncope complicates immediate-risk pulmonary emboli

Syncope signals a more complicated in-hospital disease course in patients with immediate-risk pulmonary emboli (PE) with right ventricular (RV) involvement, reports a new study.

Researchers conducted a retrospective analysis of 212 patients (mean age, 65.1±16 years; 56 percent female) with normotensive PE, with slight evidence of RV involvement. Outcomes included major adverse clinical events (MACEs), described as one or a combination of mechanical ventilation, the need for reperfusion therapy and haemodynamic instability. In-hospital mortality was also identified as a study endpoint.

The in-hospital course of disease was significantly more complicated in participants who presented with syncope. MACEs, for example, occurred around thrice as much than in patients without syncope (29 percent vs 9.4 percent; p=0.003). This was confirmed through multivariate analysis, adjusting for potential confounders (odds ratio, 3.8, 95 percent confidence interval, 1.48–9.76; p=0.005).

Such an outcome was driven by a significantly greater need for inotropic support (10 percent vs 0.6 percent; p=0.005) and mechanical ventilation (10 percent vs 1.8 percent; p=0.03), as well as by a higher incidence of haemodynamic instability (18 percent vs 3 percent; p=0.02).

Bleeding also occurred more commonly in those with syncope (15 percent vs 2.4 percent; p=0.004), while rates of in-hospital and 90-day mortality were comparable between groups.

“Our findings suggest that intermediate-risk PE patients presenting with syncope might benefit from an interim intensive surveillance, including continuous monitoring and ongoing assessment for consideration of escalation therapy beyond anticoagulation,” said researchers.