PE prevalence low in patients presenting to ED with syncope

  • Badertscher P & al.
  • J Am Coll Cardiol
  • 13 Aug 2019

  • International Clinical Digest
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Takeaway

Why this matters

  • The disputed PESIT yielded a 17% PE prevalence in patients with syncope hospitalized for a first episode.
  • Mechanism of syncope in haemodynamically stable PE patients is unclear.

Key results

  • PE ruled in 19 patients (1.4%; 95% CI, 0.87%-2.11%).
  • PE prevalence in subgroup of:
    • Hospitalised patients (n=656): 2.3% (95% CI, 1.4%-3.7%).
    • Hospitalised patients with first syncopal episode (n=254): 4.3% (95% CI, 2.4%-7.6%).
  • New PEs or cardiovascular death at 2 years: 0.9% (95% CI, 0.5%-1.5%).

Study design

  • Prospective international multicentre diagnostic BASEL IX (n=1397).
  • For unselected ED patients presenting after syncope, researchers assigned pretest Wells score (“likely” vs “unlikely”), checked D-dimer.
  • Participants otherwise underwent guideline-based syncope workup.
  • PE imaging done at physician discretion.
  • Outcomes: PE prevalence at index visit; 2-year incidence of new PEs and cardiovascular death.
  • Funding: Swiss, Australian foundations and universities; industry.

Limitations

  • Results may not apply to outpatients or haemodynamically unstable patients.

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