Abstract 10410: One-Year Mortality of Patients Hospitalized with Unexplained Syncope: Current Risk Stratification Criteria Overestimate Risk
Background: Syncope is a common cause for hospital admission. Since patients (pts) with a cardiac etiology for syncope have high mortality, recent practice guidelines emphasize the need for risk stratification. Two recent studies (EGSYS, OESIL) have proposed simple scoring criteria that identify pts with syncope who have high 1-year mortality. We sought to validate these criteria prospectively in pts hospitalized for evaluation of syncope.
Methods: We enrolled consecutive pts hospitalized at our institution for further evaluation of unexplained syncope. All pts underwent a history and physical, ECG, echo, and ≥24 hrs of telemetry. Additional tests were performed as necessary. All pts had at least 1-year follow-up. The primary outcome was 1-year mortality.
Results: We enrolled 200 pts (69 ± 17 yrs, 52% male), including 75 (28%) pts with prior syncope. Most (182 [91%] pts) were in sinus rhythm. Bundle branch block was present in 14 (7%) pts. LV function was assessed in 186 (93%) pts and was normal in 162 (87%). Two-thirds of the cohort was high-risk based on both OESIL (score ≥ 2) and EGSYS (score ≥ 3, TABLE). The median hospitalization was 3 days (IQR 2, 6); the major discharge diagnoses were vasovagal syncope (n=90 [45%] and unknown (n=46 [23%]). Devices were placed in 23 (12%) pts; this included an ILR (n=6), PPM (n=9), and an ICD (n=8). During a mean follow-up of 355 ± 51 days, 12 pts died (6%). Although our hospitalized pts were largely high-risk, the overall 1-year mortality in our cohort was lower than suggested by both OESIL and EGSYS (TABLE).
Conclusions: Our data confirm that pts with unexplained syncope classified as low-risk by OESIL and EGSYS indeed have excellent 1-year survival. However, while high-risk pts do have worse prognosis, their prognosis is significantly better than previously suggested.
- © 2011 by American Heart Association, Inc.