Utility of brain natriuretic peptide assay as a predictor of short term outcomes in patients presenting with syncope to the emergency department.
BACKGROUND
Syncope is a common condition that accounts for 3% of emergency department (ED) visits and 1-6% of hospital admissions. Current admissions practices result in marginal diagnostic and therapeutic benefit and consume healthcare resources.


METHODS
This prospective cohort study examined the use of brain natriuretic peptide (BNP) test as a predictor of short term serious outcome in 159 patients who presented to ED with syncope between August 2012 and August 2013 in two tertiary teaching medical centers.


RESULTS
A total of 41 patients (36%) had serious outcomes within 1 month, 21 of them were in the low BNP group and 20 were in the high BNP group. There was a significantly higher incidence of serious outcomes, myocardial infarction (MI), and life-threatening arrhythmias in the high BNP group. Patients with BNP >250 has an 8.844 fold increase risk of serious outcomes [odds ratio (OR) 8.844, 95% CI: (3.281 to 23.8), P<0.001], a 14.8-fold increase risk of MI [OR =14.8, 95% CI: (1.57 to 139), P=0.011], and a 4.46-fold increase risk life threatening arrhythmia [OR =4.46, 95% CI: (1.15-18.8), P=0.034]. However, there was no statistically significant difference between the two groups in one month mortality, major bleeding, major cardiac procedures or stroke.


CONCLUSIONS
Our study results further validates the ROSE rule and the utility of BNP in risk stratification of syncope patients. This study showed that measuring BNP and adding ROSE rule to the standard evaluation of syncope can sufficiently predict short-term serious outcomes for patients presenting to ED with syncope.
1 Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA ; 2 Department of Cardiology, Saint Joseph Regional Medical Center, New York Medical College, New Jersey, USA ; 3 Seton Hall University School of Health and Medical Sciences, South Orange, NJ, USA.
Ahmad
A
Isbitan
1 Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA ; 2 Department of Cardiology, Saint Joseph Regional Medical Center, New York Medical College, New Jersey, USA ; 3 Seton Hall University School of Health and Medical Sciences, South Orange, NJ, USA.
Amer
A
Hawatmeh
1 Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA ; 2 Department of Cardiology, Saint Joseph Regional Medical Center, New York Medical College, New Jersey, USA ; 3 Seton Hall University School of Health and Medical Sciences, South Orange, NJ, USA.
Yaser
Y
Elnahar
1 Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA ; 2 Department of Cardiology, Saint Joseph Regional Medical Center, New York Medical College, New Jersey, USA ; 3 Seton Hall University School of Health and Medical Sciences, South Orange, NJ, USA.
Kunal
K
Patel
1 Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA ; 2 Department of Cardiology, Saint Joseph Regional Medical Center, New York Medical College, New Jersey, USA ; 3 Seton Hall University School of Health and Medical Sciences, South Orange, NJ, USA.
Zaid
Z
Altheeb
1 Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA ; 2 Department of Cardiology, Saint Joseph Regional Medical Center, New York Medical College, New Jersey, USA ; 3 Seton Hall University School of Health and Medical Sciences, South Orange, NJ, USA.
Vincent
V
Debari
1 Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA ; 2 Department of Cardiology, Saint Joseph Regional Medical Center, New York Medical College, New Jersey, USA ; 3 Seton Hall University School of Health and Medical Sciences, South Orange, NJ, USA.
Ayman
A
Hamdan
1 Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA ; 2 Department of Cardiology, Saint Joseph Regional Medical Center, New York Medical College, New Jersey, USA ; 3 Seton Hall University School of Health and Medical Sciences, South Orange, NJ, USA.
Fayez
F
Shamoon
ROSE rule; Syncope; brain natriuretic peptide (BNP); emergency medicine