Syncope paradox in the outcome of patients with pulmonary thromboembolism: short‐term and midterm outcome

Background and Aim We compare the early and midterm outcomes of pulmonary thromboembolism ( PTE ) in patients with and without syncope in our single‐center registry. Method Between D ecember 2006 and M ay 2013, 351 consecutive patients (mean age = 60.21 ± 16.91 years, 55.3% male) with confirmed acute symptomatic PTE were divided in with and without syncope groups. Groups were compared in terms of the effect of syncope on 30‐day mortality and adverse events, and mortality in a median follow‐up time of 16.9 months. Results From 351 patients, 39 (11.1%) had syncope and 312 (88.9%) did not. Syncope group had less frequently chest pain (30.8% vs 51.4%; P value = 0.015). Also, the rates of 30‐day adverse events and mortality were 12.8% and 5.1% for the group with syncope, and 14.4% and 10.3% for the group without syncope, respectively, with no significant difference. At follow up, 65 patients died and mortality was 18.5% for 351 patients (5.1% in the group with syncope and 20.2% for the other group). After adjustment for confounding factors, the effect of syncope on 30‐day adverse events and mortality remained non‐significant and on the midterm mortality was significant, showing that the presence of syncope was associated with lower midterm mortality ( P value = 0.038). Conclusion Among PTE patients in our registry, 11.1% presented with syncope. Relationship between syncope and 30‐day adverse events and mortality remained non‐significant after adjustments for other factors. However, in midterm follow up, patients with syncope were significantly at decreased risk of mortality compared to those without syncope.