Predicting recurrence of vasovagal syncope: a simple risk score for the clinical routine.
BACKGROUND
Predictors for recurrence of syncope are lacking in patients with vasovagal syncope. The aim of this study was to identify risk factors for recurrence of syncope and develop a simple prognostic risk score of clinical value.


METHODS
Two hundred seventy-six patients with a history of vasovagal syncope were prospectively followed for 2 years. Diagnosis of vasovagal syncope was based on clinical history and negative standard work-up. Inclusion in the study was independent from the result of the head-up tilt test, which was performed in all cases. Risk factors for syncope recurrence were evaluated by the Cox proportional hazards regression model and implemented in a risk score, which was validated with the log-rank test and an internal cross-validation.


RESULTS
The Cox-regression analysis identified the number of previous syncopal events, history of bronchial asthma, and female gender as predictors for syncope recurrence (all P < 0.05). In contrast, head-up tilt test response had no predictive value (P = 0.881). Developing a risk score, study patients were identified as having high (recurrence rate during 2 years of follow-up: 37.2%), intermediate (24.8%), and low (6.5%) risk for syncope recurrence (receiver operating characteristic [ROC] of score 0.83, P < 0.01; Log-rank test for event-free survival, P < 0.005).


CONCLUSIONS
In patients with vasovagal syncope, risk of recurrence can be stratified and is predictable based on a simple risk score.
Aydin
Muhammet A
MA
Department of Cardiology, University Heart Center, Hamburg, Germany. aydin@uke.de
Maas
Renke
R
Mortensen
Kai
K
Steinig
Tobias
T
Klemm
Hanno
H
Risius
Tim
T
Meinertz
Thomas
T
Willems
Stephan
S
Morillo
Carlos A
CA
Ventura
Rodolfo
R
D000328:Adult; D000368:Aged; D001249:Asthma / Q000150:complications; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D019462:Syncope, Vasovagal / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D018667:Tilt-Table Test; D013997:Time Factors