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Cited by 285Cardiovascular Syncope and Autonomic DisordersCardiac electrophysiology and arrhythmiasCardiovascular and Diving-Related Complications

Risk stratification of patients with syncope

Martin, Thomas P, Hanusa, Barbara H, Kapoor, Wishwa N·1997·Annals of Emergency Medicine
DOI 10.1016/s0196-0644(97)70217-8
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Abstract

Study objective To develop and validate a risk classification system for patients presenting to emergency departments with syncope.Methods Two prospective studies were carried out at a large urban teaching hospital ED. One cohort of 252 patients with syncope who reported to the ED was used to develop the risk classification system; a second cohort of 374 patients with syncope was used to validate the system. Data from the patient's history, physical examination and ED ECG were used to identify predictors of arrhythmias or mortality within the first year. Arrhythmias were detected by cardiac monitoring or electrophysiologic studies. Logistic regression and Cox proportional hazards models were used to identify the important risk factors for the classification system. Performance of the system was measured by comparing the proportion of patients with arrhythmias or death at various levels of the risk and receiver operating characteristic curves.Results Multivariate predictors of arrhythmia or 1-year mortality were an abnormal ED ECG (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.6 to 6.4); history of ventricular arrhythmia (OR, 4.8; 95% CI, 1.7 to 13.9); history of congestive heart failure (OR, 3.2; 95% Cl, 1.3 to 8.1). Arrhythmias or death within 1 year occurred in 7.3% (derivation cohort) to 4.4% (validation cohort) of patients without any risk factors and in 80.4% (derivation) to 57.6% (validation) of patients with three or four risk factors.Conclusion Historical and ECG factors available at the time of presentation can be used to stratify risk of arrhythmias or mortality within 1 year in ED patients presenting with syncope.

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  • Cardiac ischaemia-related syncope is confirmed when syncope presents with evidence of acute myocardial ischaemia with or without myocardial infarction.

    “Cardiac ischaemia-related syncope is confirmed when syncope presents with evidence of acute myocardial ischaemia with or without myocardial infarction. 25-39”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [34]

  • Arrhythmic syncope is highly probable when the ECG shows persistent sinus bradycardia <40 b.p.m. or sinus pauses >3 s in awake state and in absence of physical training; Mobitz II second- and third-degree AV block; alternating left and right BBB; VT or rapid paroxysmal SVT.

    “Arrhythmic syncope is highly probable when the ECG shows 25-39 : • Persistent sinus bradycardia <40 b.p.m. or sinus pauses >3 s in awake state and in absence of physical training; • Mobitz II second- and third-degree AV block; • Alternating left and right BBB; • VT or rapid paroxysmal SVT;”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [34]

  • Presence of ≥1 serious medical condition is the key determinant for further in-hospital management of patients after syncope.

    “Presence of ≥1 serious medical condition, summarized in Table 7, is the key determinant for further in-hospital management of patients after syncope (90,98).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [90]

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Authors
Martin, T. P., Hanusa, B. H., & Kapoor, W. N.
Affiliations
University of Pittsburgh (US)
ORCID
Hanusa, Barbara H
Venue
Annals of Emergency Medicine
Publisher
Elsevier BV
Published
1997-04
Volume
29
Issue
4
Pages
459-466
ISSN
0196-0644 (ISSN-L)
DOI
10.1016/s0196-0644(97)70217-8
OpenAlex
W2156112512
Cited by
285
References
22
Citations by year
2026: 2 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 3 · 2021: 4 · 2020: 8 · 2019: 6 · 2018: 12 · 2017: 14 · 2016: 9 · 2015: 12 · 2014: 21 · 2013: 15 · 2012: 21
FWCI
4.85
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Annals of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Heart, Lung, and Blood Institute (K04L 01899, RO1 HL36735)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
Keywords
syncope, risk stratification, risk classification system, ventricular arrhythmias, mortality, emergency department, electrocardiographic abnormalities, congestive heart failure, risk factors, cardiac monitoring
MeSH terms
Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Arrhythmias, Cardiac, Electrocardiography, Female, Humans, Male, Middle Aged, Physical Examination, Prospective Studies, Risk Factors, ROC Curve, Syncope, Cohort Studies, Multivariate Analysis, Logistic Models, Odds Ratio, Death, Sudden, Cardiac, Tachycardia, Ventricular, Risk Assessment

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