Differential impact of syncope on the prognosis of patients with acute pulmonary embolism: a systematic review and meta-analysis.

Autor:	Barco S; Center for Thrombosis and Haemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, Mainz, Germany., Ende-Verhaar YM; Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Albinusdreef 2, RC, Leiden, the Netherlands., Becattini C; Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, via Dottori 1, Perugia, Italy., Jimenez D; Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (IRYCIS), Ctra. Colmenar Km. 9,100, Madrid, Spain., Lankeit M; Center for Thrombosis and Haemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, Mainz, Germany.; Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité - University Medicine Berlin, Augustenburger Platz 1, Berlin, Germany.; Clinic for Cardiology and Pneumology, Georg-August University of Göttingen, Göttingen, Germany., Huisman MV; Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Albinusdreef 2, RC, Leiden, the Netherlands., Konstantinides SV; Center for Thrombosis and Haemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, Mainz, Germany.; Department of Cardiology Democritus University of Thrace, University General Hospital, Alexandroupolis, Greece., Klok FA; Center for Thrombosis and Haemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, Mainz, Germany.; Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Albinusdreef 2, RC, Leiden, the Netherlands.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2018 Dec 14; Vol. 39 (47), pp. 4186-4195.
DOI:	10.1093/eurheartj/ehy631
Abstrakt:	Aims: Controversial reports exist in the literature regarding the prognostic role and therapeutic implications of syncope in patients with acute pulmonary embolism (PE). We conducted a systematic review and meta-analysis to investigate the association between syncope and short-term adverse outcomes, taking into account the presence or absence of haemodynamic compromise at acute PE presentation. Methods and Results: The literature search identified 1664 studies, 29 of which were included for a total of 21 956 patients with PE (n = 3706 with syncope). Syncope was associated with higher prevalence of haemodynamic instability [odds ratio (OR) 3.50; 95% confidence interval (CI) 2.67-4.58], as well as with echocardiographic signs of right ventricular (RV) dysfunction (OR 2.10; CI 1.60-2.77) at presentation. Patients with syncope had a higher risks of all-cause early (either in-hospital or within 30 days) death (OR 1.73; CI 1.22-2.47) and PE-related 30-day adverse outcomes (OR 2.00; CI 1.11-3.60). The absolute risk difference (95% CI) for all-cause death was +6% (+1% to +10%) in studies including unselected patients, but it was -1% (-2% to +1%) in studies restricted to normotensive patients. We observed no prognostic impact of syncope in studies with a lower score at formal quality assessment and in those conducted retrospectively. Conclusion: Syncope as a manifestation of acute PE was associated with a higher prevalence of haemodynamic instability and RV dysfunction at presentation, and an elevated risk for early PE-related adverse outcomes. The association with an increased risk of early death appeared more prominent in studies including unselected patients, when compared with those focusing on normotensive patients only.
Databáze:	MEDLINE
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