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Zimmermann, Tobias; du Fay de Lavallaz, Jeanne; Nestelberger, Thomas; Gualandro, Danielle M; Strebel, Ivo; Badertscher, Patrick; Lopez-Ayala, Pedro; Widmer, Velina; Freese, Michael; Miró, Òscar; Christ, Michael; Cullen, Louise; Than, Martin; Martin-Sanchez, F Javier; Di Somma, Salvatore; Peacock, W Frank; Keller, Dagmar I; Boeddinghaus, Jasper; Twerenbold, Raphael; Wussler, Desiree; Koechlin, Luca; Walter, Joan E; Bürgler, Franz; Geigy, Nicolas; [...]

Incidence, characteristics, determinants, and prognostic impact of recurrent syncope

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  • Media type: E-Article
  • Title: Incidence, characteristics, determinants, and prognostic impact of recurrent syncope
  • Contributor: Zimmermann, Tobias; du Fay de Lavallaz, Jeanne; Nestelberger, Thomas; Gualandro, Danielle M; Strebel, Ivo; Badertscher, Patrick; Lopez-Ayala, Pedro; Widmer, Velina; Freese, Michael; Miró, Òscar; Christ, Michael; Cullen, Louise; Than, Martin; Martin-Sanchez, F Javier; Di Somma, Salvatore; Peacock, W Frank; Keller, Dagmar I; Boeddinghaus, Jasper; Twerenbold, Raphael; Wussler, Desiree; Koechlin, Luca; Walter, Joan E; Bürgler, Franz; Geigy, Nicolas; [...]
  • imprint: Oxford University Press (OUP), 2020
  • Published in: EP Europace
  • Language: English
  • DOI: 10.1093/europace/euaa227
  • ISSN: 1099-5129; 1532-2092
  • Keywords: Physiology (medical) ; Cardiology and Cardiovascular Medicine
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims </jats:title> <jats:p>The aim of this study is to characterize recurrent syncope, including sex-specific aspects, and its impact on death and major adverse cardiovascular events (MACE).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results</jats:title> <jats:p>We characterized recurrent syncope in a large international multicentre study, enrolling patients ≥40 years presenting to the emergency department (ED) with a syncopal event within the last 12 h. Syncope aetiology was centrally adjudicated by two independent cardiologists using all information becoming available during syncope work-up and long-term follow-up. Overall, 1790 patients were eligible for this analysis. Incidence of recurrent syncope was 20% [95% confidence interval (CI) 18–22%] within the first 24 months. Patients with an adjudicated final diagnosis of cardiac syncope (hazard ratio (HR) 1.50, 95% CI 1.11–2.01) or syncope with an unknown aetiology even after central adjudication (HR 2.11, 95% CI 1.54–2.89) had an increased risk for syncope recurrence. Least Absolute Shrinkage and Selection Operator regression fit on all patient information available early in the ED identified &amp;gt;3 previous episodes of syncope as the only independent predictor for recurrent syncope (HR 2.13, 95% CI 1.64–2.75). Recurrent syncope carried an increased risk for death (HR 1.87, 95% CI 1.26–2.77) and MACE (HR 2.69, 95% CI 2.02–3.59) over 24 months of follow-up, however, with a time-dependent effect. These findings were confirmed in a sensitivity analysis excluding patients with syncope recurrence or MACE before or during ED evaluation.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion </jats:title> <jats:p>Recurrence rates of syncope are substantial and vary depending on syncope aetiology. Importantly, recurrent syncope carries a time-dependent increased risk for death and MACE.</jats:p> </jats:sec> <jats:sec> <jats:title>Trial registration</jats:title> <jats:p>BAsel Syncope EvaLuation (BASEL IX, ClinicalTrials.gov registry number NCT01548352).</jats:p> </jats:sec>
  • Access State: Open Access