Does Syncope in PE Mean Increased Mortality?

Written by Clay Smith

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PE with syncope is associated with increased risk of short-term mortality, which is explained by the increase in hemodynamic instability seen in these patients as well.

Why does this matter?
PESIT raised concern that 1 in 6 patients admitted with syncope had PE. Subsequently, the rate has been shown to be significantly less than that. But when a patient has a PE + syncope, does that portend a bad outcome?

Not all syncope is PE, but PE with syncope is bad.
This was a meta-analysis of 20 studies, pooling 9,419 patients. They found that when a patient had syncope associated with PE, the odds of short-term mortality increased 82% (OR 1.82, 95%CI 1.14 to 2.90). Odds of hemodynamic instability was also much greater in patients with syncope (OR 4.36, 95%CI 2.27 to 8.37). In fact, the increased risk of mortality in patients with PE + syncope was explained by the increase in hemodynamic instability. The authors point out that this is why it is important to use hemodynamic status to risk stratify patients who present with PE and syncope.

Source
The Prognostic Value of Syncope on Mortality in Patients With Pulmonary Embolism: A Systematic Review and Meta-analysis. Ann Emerg Med. 2020 May 24. pii: S0196-0644(20)30216-X. doi: 10.1016/j.annemergmed.2020.03.026. [Epub ahead of print]

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