Does Syncope Predict Mortality in Patients With Acute Pulmonary Embolism? A Retrospective Review

BACKGROUND: Acute pulmonary embolism (APE) is a potentially fatal disease with high mortality. Prior studies have shown an increased frequency of central localization of the clot, right ventricular dysfunction and elevated troponin in patients who present with syncope and APE. Existing evidence regarding mortality and length of hospital stay in these patients is unclear. METHODS: We retrospectively reviewed electronic medical records of patients who were admitted in a tertiary care hospital in rural Upstate New York and diagnosed with APE from July 2014 to July 2016. Two hundred nineteen patients were reviewed in two groups: patients who presented with syncope and those without syncope. RESULTS: The prevalence of syncope was found to be 6.8% (15/219). Hypotension on admission was more common among patients with syncope compared to no syncope (26.7% and 7.4%, respectively, P = 0.03). A clinically significant difference was found in 30-day mortality among those with syncope versus no syncope (21.3% vs. 7.4%, P = 0.096). No significant difference was found in length of stay (mean 6.7 days in patients with syncope vs. 6.4 without syncope, P = 0.783), central localization (26.7% with syncope vs. 43.2% without syncope, P = 0.21) or troponin elevation (46.2% in patients with syncope vs. 27.9% without syncope, P = 0.205). On multivariable analysis, hypotension was significantly higher among those with syncope (odds ratio: 5.23, P = 0.0148). CONCLUSION: This study suggests 30-day mortality may be higher among patients with syncope. It is important to risk stratify patients on admission in order to reduce mortality and morbidity associated with lethal disease.