Short- and long-term prognosis of syncope, risk factors, and role of hospital admission: results from the STePS (Short-Term Prognosis of Syncope) study.
OBJECTIVE
We sought to assess short- and long-term prognosis of syncope and associated risk factors.


BACKGROUND
Syncope is a common clinical event, but our knowledge of its short-term outcome is largely incomplete. Further, it is unknown whether hospital admission might positively affect a patient's syncope prognosis.


METHODS
We screened 2,775 consecutive subjects who presented for syncope at 4 emergency departments between January and July 2004. Short- and long-term severe outcomes (i.e., death and major therapeutic procedures) and related risk factors were compared in all enrolled patients arrayed according to hospital admission or discharge.


RESULTS
A total of 676 subjects were included in the study. Forty-one subjects (6.1%) experienced severe outcomes (5 deaths, 0.7%; 36 major therapeutic procedures, 5.4%) in the 10 days after presentation. An abnormal electrocardiogram, concomitant trauma, absence of symptoms of impending syncope, and male gender were associated with short-term unfavorable outcomes. Long-term severe outcomes were 9.3% (40 deaths, 6.0%; 22 major therapeutic procedures, 3.3%), and their occurrence was correlated with an age >65 years, history of neoplasms, cerebrovascular diseases, structural heart diseases, and ventricular arrhythmias. Short-term major therapeutic procedures were more common (p < 0.05) in subjects who had been admitted to hospital (13.3%) than in discharged (1.6%), whereas mortality was similar. One-year mortality was greater (p < 0.05) in admitted (14.7%) than in discharged (1.8%) patients.


CONCLUSIONS
Risk factors for short- and long-term adverse outcomes after syncope differed. Hospital admission favorably influenced syncope short term prognosis. Instead, 1-year mortality was unaffected by hospital admission and related to comorbidity.
Costantino
Giorgio
G
Syncope Unit, Internal Medicine II, L. Sacco Hospital, University of Milan, Milan, Italy.
Perego
Francesca
F
Dipaola
Franca
F
Borella
Marta
M
Galli
Andrea
A
Cantoni
Giulia
G
Dell'Orto
Simonetta
S
Dassi
Simonetta
S
Filardo
Nicola
N
Duca
Pier Giorgio
PG
Montano
Nicola
N
Furlan
Raffaello
R
D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001145:Arrhythmias, Cardiac / Q000150:complications*; D002318:Cardiovascular Diseases / Q000150:complications; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013575:Syncope / Q000150:complications* / Q000401:mortality*