Author + information
- Received February 5, 2019
- Revision received May 19, 2019
- Accepted June 3, 2019
- Published online August 5, 2019.
- Patrick Badertscher, MDa,b,c,∗@BadertscherPat,
- Jeanne du Fay de Lavallaz, MDa,b,∗@JDFDLz,
- Angelika Hammerer-Lercher, MDd,
- Thomas Nestelberger, MDa,b,
- Tobias Zimmermann, MDa,b,
- Marc Geiger, MDa,b,
- Orell Imahorn, MDa,b,
- Òscar Miró, MDb,e,
- Emilio Salgado, MDb,e,
- Michael Christ, MDf,
- Louise Cullen, MD, PhDb,g,
- Martin Than, MDb,h,
- F. Javier Martin-Sanchez, MDb,i,
- Salvatore Di Somma, MD, PhDb,j,
- W. Frank Peacock, MDb,k,
- Dagmar I. Keller, MDl,
- Juan Pablo Costabel, MDm,
- Joan Walter, MDa,b,
- Jasper Boeddinghaus, MDa,b,
- Raphael Twerenbold, MDa,b,
- Adriana Méndez, MDd,
- Boris Gospodinov, MDd,
- Christian Puelacher, MDa,b,n,
- Desiree Wussler, MDa,b,
- Luca Koechlin, MDa,b,o,
- Damian Kawecki, MDb,p,
- Nicolas Geigy, MDq,
- Ivo Strebel, PhDca,b,
- Jens Lohrmann, MDa,
- Michael Kühne, MDa,
- Tobias Reichlin, MDa,r,
- Christian Mueller, MDa,b,∗ (, )@CRIBasel,
- for the BASEL IX Investigators
- aCardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- bGREAT network, Rome, Italy
- cDepartment of Cardiology, University of Illinois at Chicago, Chicago, Illinois
- dDepartment of Laboratory Medicine, Kantonsspital Aarau, Switzerland
- eHospital Clinic, Barcelona, Catalonia, Spain
- fGeneral Hospital, Paracelsus Medical University, Nürnberg, Germany
- gRoyal Brisbane & Women's Hospital, Herston, Queensland, Australia
- hChristchurch Hospital, Christchurch, New Zealand
- iServicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
- jEmergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant’Andrea Hospital, Rome, Italy
- kDepartment of Emergency Medicine, Baylor College of Medicine, Houston, Texas
- lUniversity Hospital Zürich, Zürich, Switzerland
- mInstituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
- nDepartment of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- oDepartment of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
- p2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
- qEmergency Department, Kantonsspital Liestal, Liestal, Switzerland
- rDepartment of Cardiology, Inselspital Bern, Bern, Switzerland
- ↵∗Address for correspondence:
Prof. Christian Müller, CRIB and Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
Background The prevalence of pulmonary embolism (PE) in patients presenting with syncope to the emergency department (ED) is largely unknown. This information, however, is necessary to balance the potential medical benefit or harm of systematic PE screening in patients presenting with syncope to the ED.
Objectives This study sought to determine the prevalence of PE in patients with syncope.
Methods Unselected patients presenting with syncope to the ED were prospectively enrolled in a diagnostic multicenter study. Pre-test clinical probability for PE was assessed using the 2-level Wells score and the results of D-dimer testing using age-adapted cutoffs. Presence of PE was evaluated by imaging modalities, when ordered as part of the clinical assessment by the treating ED physician or by long-term follow-up data.
Results Long-term follow-up was complete in 1,380 patients (99%) at 360 days and 1,156 patients (83%) at 720 days. Among 1,397 patients presenting with syncope to the ED, PE was detected at presentation in 19 patients (1.4%; 95% confidence interval [CI]: 0.87% to 2.11%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.5% to 1.5%). In the subgroup of patients hospitalized (47%), PE was detected at presentation in 15 patients (2.3%; 95% CI: 1.4% to 3.7%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.4% to 2.0%).
Conclusions PE seems to be a rather uncommon cause of syncope among patients presenting to the ED. Therefore, systematic PE-screening in all patients with syncope does not seem warranted. (BAsel Syncope EvaLuation Study [BASEL IX]; NCT01548352)
↵∗ Drs. Badertscher and du Fay de Lavallaz contributed equally to this work.
This work was supported by research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel (Switzerland), the University of Basel (Switzerland), Abbott, BRAHMS, Singulex, the University Hospital Basel (Switzerland), and the Emergency Medicine Foundation (Australia). Dr. Badertscher has received research funding from the “University of Basel,” the “Stiftung für Herzschrittmacher und Elektrophysiologie,” and the “Freiwillige Akademische Gesellschaft Basel.” Dr. Nestelberger has received speaker/consulting honoraria from Beckman-Coulter. Dr. Cullen has received grants and personal fees from Abbott Diagnostics and Siemens (outside of the submitted work); and has received personal fees from Beckman Coulter. Dr. Than has received grants and personal fees from Abbott, Alere, and Roche (outside of the submitted work); and has received grants from Beckman. Dr. Martin-Sanchez has received speaker, advisory, or consulting fees from Novartis, Merck Sharp & Dohme, Bristol-Myers Squibb, Pfizer, The Medicines Company, Otsuka, Thermo Fisher, Cardiorentis, and Sanofi; and has received research grants from the Spanish Ministry of Health and FEDER, Mapfre, Novartis, Bayer, Merck Sharp & Dohme, Abbott, and Orion-Pharma. Dr. Peacock has received research grants from Abbott, Braincheck, Immunarray, Janssen, Roche, and ZS Pharma; has served as a consultant for Abbott, AstraZeneca, Bayer, Beckman, Boehrhinger Ingelheim, Ischemia Care, Dx, Immunarray, Instrument Labs, Janssen, Ortho Clinical Diagnostics, Relypsa, Roche, and Siemens; has provided expert testimony for Johnson and Johnson; and has ownership interests in Comprehensive Research Associates LLC, and Emergencies in Medicine LLC, Ischemia DX, LLC. Dr. Boeddinghaus has received support from the University Hospital Basel (Division of Internal Medicine), the Swiss Academy of Medical Sciences and Julia und Gottfried Bangerter-Rhyner-Stiftung; and has received speaker/consulting honoraria from Siemens. Dr. Twerenbold has received grants from the Swiss National Science Foundation (Grant No P300PB_167803), the University Hospital Basel, the University of Basel and the Cardiovascular Research Foundation Basel; and has received consulting/speaker honoraria from Roche Diagnostics, Abbott Diagnostics, Siemens, Singulex, and Brahms, outside of the submitted work. Dr. Puelacher has received a research grant from Roche Diagnostics (outside of the submitted study). Prof. Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union, the KTI, the Cardiovascular Research Foundation Basel, Abbott, AstraZeneca, Biomerieux, Beckman Coulter, BRAHMS, Critical Diagnostics, Indorsia, Radiometer, Roche, Siemens, and Singulex; and has received speaker/consulting honoraria or travel support from Abbott, Amgen, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, BRAHMS, Cardiorentis, Daiichi-Sankyo, Indorsia, Novartis, Roche, Sanofi, Siemens, and Singulex. Dr. Kühne has received personal fees from Bayer, Daiichi-Sankyo, Pfizer-Bristol-Myers Squibb, and Boehringer Ingelheim, outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received February 5, 2019.
- Revision received May 19, 2019.
- Accepted June 3, 2019.
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