Early and late outcome of treated patients referred for syncope to emergency department: the EGSYS 2 follow-up study.
OBJECTIVE
We evaluated the early (1 month) and late (2 years) death rate and syncopal relapses of patients referred for syncope to 11 general hospitals emergency departments. Patients were enrolled in the Evaluation of Guidelines in SYncope Study 2 (EGSYS 2) study. The guidelines of the European Society of Cardiology were strictly followed in the management of patients.


RESULTS
Out of the 465 patients enrolled in the EGSYS 2 study, 398 (86%) underwent a complete follow-up. We excluded 18 patients with non-syncopal attacks. Among the remaining 380 patients, death of any cause occurred in 35 (9.2%). The mean follow-up was 614 +/- 73 days. Six deaths (17% of total) occurred during the first month of follow-up. Patients who died were older, had a higher incidence of structural heart disease and/or abnormal ECG, had injuries related to syncope and higher EGSYS score. Syncope recurred in 63 (16.5%) patients. Syncopal relapses occurred in only one patient during the first month of follow-up. The incidence of syncopal recurrences was unrelated to the mechanism of syncope. No clinical differences were found between patients with or without syncopal recurrence and in patients with EGSYS score < or >or=3.


CONCLUSIONS
A peak of cardiovascular mortality but not of syncopal recurrences was observed in patients attending to the emergency department for syncope within the first month. Late unfavourable outcomes were caused by associated cardiovascular diseases rather than by the mechanism of syncope. The causes of syncope did not determine the recurrence rate.
Ungar
Andrea
A
Unit of Geriatric Cardiology and Medicine, Department of Critical Care Medicine and Surgery, University of Florence, Viale Pieraccini 6, 50141 Florence, Italy. aungar@unifi.it
Del Rosso
Attilio
A
Giada
Franco
F
Bartoletti
Angelo
A
Furlan
Raffaello
R
Quartieri
Fabio
F
Lagi
Alfonso
A
Morrione
Alessandro
A
Mussi
Chiara
C
Lunati
Maurizio
M
De Marchi
Giuseppe
G
De Santo
Tiziana
T
Marchionni
Niccolò
N
Brignole
Michele
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012008:Recurrence; D012017:Referral and Consultation; D018570:Risk Assessment; D013575:Syncope / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult