- The BASEL IX syncope study yielded a 1.4% prevalence of pulmonary embolism (PE) among unselected emergency department (ED) patients presenting with syncope.
- Authors: findings suggest PE workup should be limited to those with additional PE signs and symptoms.
- Editorial discusses these findings in the context of Pulmonary Embolism in Syncope Italian Trial (PESIT) results.
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.
- 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%).
- 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.
- Results may not apply to outpatients or haemodynamically unstable patients.