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

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; ... (2020). Incidence, characteristics, determinants, and prognostic impact of recurrent syncope. Europace, 22(12), pp. 1885-1895. Oxford University Press 10.1093/europace/euaa227

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AIMS

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).

METHODS AND RESULTS

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 >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.

CONCLUSION

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.

TRIAL REGISTRATION

BAsel Syncope EvaLuation (BASEL IX, ClinicalTrials.gov registry number NCT01548352).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Reichlin, Tobias Roman

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1099-5129

Publisher:

Oxford University Press

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

30 Nov 2020 09:52

Last Modified:

05 Dec 2022 15:41

Publisher DOI:

10.1093/europace/euaa227

PubMed ID:

33038231

Uncontrolled Keywords:

Characteristics Incidence Prognosis Recurrence Syncope

BORIS DOI:

10.48350/147591

URI:

https://boris.unibe.ch/id/eprint/147591

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