Incidence, characteristics, determinants, and prognostic impact of recurrent syncope
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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; Koechlin, Luca; Walter, Joan E; Bürgler, Franz; Geigy, Nicolas; Kühne, Michael; Reichlin, Tobias; Lohrmann, Jens; Mueller, Christian.
In: EUROPACE, Vol. 22, No. 12, 23.12.2020, p. 1885-1895.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Incidence, characteristics, determinants, and prognostic impact of recurrent syncope
AU - Zimmermann, Tobias
AU - du Fay de Lavallaz, Jeanne
AU - Nestelberger, Thomas
AU - Gualandro, Danielle M
AU - Strebel, Ivo
AU - Badertscher, Patrick
AU - Lopez-Ayala, Pedro
AU - Widmer, Velina
AU - Freese, Michael
AU - Miró, Òscar
AU - Christ, Michael
AU - Cullen, Louise
AU - Than, Martin
AU - Martin-Sanchez, F Javier
AU - Di Somma, Salvatore
AU - Peacock, W Frank
AU - Keller, Dagmar I
AU - Boeddinghaus, Jasper
AU - Twerenbold, Raphael
AU - Wussler, Desiree
AU - Koechlin, Luca
AU - Walter, Joan E
AU - Bürgler, Franz
AU - Geigy, Nicolas
AU - Kühne, Michael
AU - Reichlin, Tobias
AU - Lohrmann, Jens
AU - Mueller, Christian
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
PY - 2020/12/23
Y1 - 2020/12/23
N2 - 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).
AB - 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).
KW - Emergency Service, Hospital
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Prognosis
KW - Proportional Hazards Models
KW - Syncope/diagnosis
U2 - 10.1093/europace/euaa227
DO - 10.1093/europace/euaa227
M3 - SCORING: Journal article
C2 - 33038231
VL - 22
SP - 1885
EP - 1895
JO - EUROPACE
JF - EUROPACE
SN - 1099-5129
IS - 12
ER -
