Presence and extent of cardiac computed tomography angiography defined coronary artery disease in patients presenting with syncope.
BACKGROUND
In syncope patients, presence of coronary artery disease (CAD) is associated with poor prognosis. However, data concerning CAD prevalence in syncope patients without known cardiovascular disease are lacking. Therefore, the aim of this study was to investigate presence and extent of CAD in syncope patients.


METHODS
We included 142 consecutive patients presenting with syncope at the outpatient cardiology clinic who underwent coronary computed tomography (CT) angiography. Syncope type was ascertained by two reviewers, blinded for coronary CT angiography results. Of the patients, 49 had cardiac syncope (arrhythmia or structural cardiopulmonary disease) and 93 had non-cardiac syncope (reflex [neurally-mediated], orthostatic or of unknown cause). Cardiac syncope patients were compared with matched stable chest pain patients regarding age, gender, smoking status, diabetes mellitus type 2 and systolic blood pressure.


RESULTS
Distribution of CAD presence and extent in cardiac and non-cardiac syncope patients was as follows: 72% versus 48% any CAD; 31% versus 26% mild, 8% versus 14% moderate and 33% versus 7% severe CAD. Compared with non-cardiac syncope, patients with cardiac syncope had a significantly higher CAD presence and extent (p = 0.001). Coronary calcium score, segment involvement and stenosis score were also higher in cardiac syncope patients (p-values ≤0.004). Compared to the chest pain control group, patients with cardiac syncope showed a higher, however, non-significant, prevalence of any CAD (72% versus 63%) and severe CAD (33% versus 19%).


CONCLUSIONS
Patients with cardiac syncope show a high presence and extent of CAD in contrast to non-cardiac syncope patients. These results suggest that CAD may play an important role in the occurrence of cardiac syncope.
Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.
S
S
Altintas
Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.
T
T
Dinh
Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, MUMC+, Maastricht, The Netherlands.
N G H M
NGHM
Marcks
Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, MUMC+, Maastricht, The Netherlands.|Department of Radiology, MUMC+, Maastricht, The Netherlands.
M
M
Kok
Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands.
A J J
AJJ
Aerts
Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.
B
B
Weijs
Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
Y
Y
Blaauw
Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, MUMC+, Maastricht, The Netherlands.|Department of Radiology, MUMC+, Maastricht, The Netherlands.
J E
JE
Wildberger
Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, MUMC+, Maastricht, The Netherlands.|Department of Radiology, MUMC+, Maastricht, The Netherlands.
M
M
Das
Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, MUMC+, Maastricht, The Netherlands.|Department of Radiology, MUMC+, Maastricht, The Netherlands.
B L J H
BLJH
Kietselaer
Department of Cardiology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands. hjgm.crijns@mumc.nl.|Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, MUMC+, Maastricht, The Netherlands. hjgm.crijns@mumc.nl.
H J G M
HJGM
Crijns
Cardiogenic syncope; Coronary artery disease; Multidetector computed tomography