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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Short- and Long-Term Prognosis of Syncope, Risk Factors, and Role of Hospital Admission

Results From the STePS (Short-Term Prognosis of Syncope) Study

Giorgio Costantino, MD^_*, Francesca Perego, MD^_*, Franca Dipaola, MD^_*, Marta Borella, MD^_*, Andrea Galli, MD^_*, Giulia Cantoni, MD, Simonetta Dell’Orto, MD, Simonetta Dassi, MD, Nicola Filardo, MD^_*, Pier Giorgio Duca, MD^||, Nicola Montano, MD, PhD^_*, Raffaello Furlan, MD^_*,_* on behalf of the STePS Investigators

^_* Syncope Unit, Internal Medicine II, "L. Sacco" Hospital, University of Milan, Milan, Italy
Emergency Medicine, "Fatebenefratelli" Hospital, Milan, Italy
Cardiology, "Uboldo" Hospital, Cernusco s. Naviglio, Milan, Italy
Internal Medicine, "S. Corona" Hospital, Garbagnate Milanese, Milan, Italy
^|| Medical Statistics, Institute of Clinical Science "L.Sacco," University of Milan, Milan, Italy.

Manuscript received April 27, 2007; revised manuscript received August 7, 2007, accepted August 13, 2007.

^_* Reprint requests and correspondence: Dr. Raffaello Furlan, Unità Sincopi e Disturbi della Postura, Medicina Interna II, Ospedale L. Sacco, Università di Milano, Via G.B. Grassi 74, 20157 Milano, Italy. (Email: raffaello.furlan{at}unimi.it).

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.

Abbreviations and Acronyms   CI = confidence interval   ECG = electrocardiogram/electrocardiographic   ED = emergency department   OR = odds ratio

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