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Prognostic significance of noncardiac syncope in the general population : A systematic review and meta-analysis

Ricci, Fabrizio LU ; Sutton, Richard ; Palermi, Stefano ; Tana, Claudio ; Renda, Giulia ; Gallina, Sabina ; Melander, Olle LU ; De Caterina, Raffaele and Fedorowski, Artur LU (2018) In Journal of Cardiovascular Electrophysiology 29(12). p.1641-1647
Abstract

Introduction: Cardiac syncope heralds significantly higher mortality compared with syncope due to noncardiac causes or unknown etiology, commonly considered a benign event. A few epidemiologic studies have examined the outcome of noncardiac/unexplained syncope comparing individuals with and without syncope, but with controversial results. We performed a systematic review and meta-analysis to clarify whether history of noncardiac/unexplained syncope is associated with increased all-cause mortality in the general population. Methods and Results: Our systematic review of the literature published between January 1, 1966, and March 31, 2018 sought prospective, observational, cohort studies reporting summary-level outcome data about all-cause... (More)

Introduction: Cardiac syncope heralds significantly higher mortality compared with syncope due to noncardiac causes or unknown etiology, commonly considered a benign event. A few epidemiologic studies have examined the outcome of noncardiac/unexplained syncope comparing individuals with and without syncope, but with controversial results. We performed a systematic review and meta-analysis to clarify whether history of noncardiac/unexplained syncope is associated with increased all-cause mortality in the general population. Methods and Results: Our systematic review of the literature published between January 1, 1966, and March 31, 2018 sought prospective, observational, cohort studies reporting summary-level outcome data about all-cause mortality in subjects with history of noncardiac/unexplained syncope compared with syncope-free participants. Adjusted hazard ratios were pooled through inverse variance random-effect meta-analysis to compute the summary effect size. Meta-regression models were performed to explore the effect of age, cardiovascular risk factors, or other potential confounders on the measured effect size. We identified four studies including 287 382 individuals (51.6% men; age, 64 ± 12 years): 38 843 with history of noncardiac/unexplained syncope and 248 539 without history of syncope. The average follow-up was 4.4 years. History of noncardiac/unexplained syncope was associated with higher all-cause mortality (pooled adjusted hazard ratio = 1.13; 95% confidence interval, 1.05 to 1.23). Meta-regression analysis showed a stronger positive relationship proportional to aging and increasing prevalence of diabetes and hypertension. Conclusions: This study-level meta-analysis showed that among older, diabetic and/or hypertensive individuals, history of noncardiac/unexplained syncope, even in the absence of an obvious cardiac etiology, is associated with higher all-cause mortality.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
all-cause mortality, cardiovascular autonomic dysfunction, meta-analysis, neutrally mediated syncope, orthostatic hypotension
in
Journal of Cardiovascular Electrophysiology
volume
29
issue
12
pages
1641 - 1647
publisher
Wiley-Blackwell
external identifiers
  • pmid:30106212
  • scopus:85054547285
ISSN
1045-3873
DOI
10.1111/jce.13715
language
English
LU publication?
yes
id
f6812a17-f60f-472e-93a6-12613d6d1396
date added to LUP
2018-11-09 12:35:12
date last changed
2020-10-20 02:41:51
@article{f6812a17-f60f-472e-93a6-12613d6d1396,
  abstract     = {<p>Introduction: Cardiac syncope heralds significantly higher mortality compared with syncope due to noncardiac causes or unknown etiology, commonly considered a benign event. A few epidemiologic studies have examined the outcome of noncardiac/unexplained syncope comparing individuals with and without syncope, but with controversial results. We performed a systematic review and meta-analysis to clarify whether history of noncardiac/unexplained syncope is associated with increased all-cause mortality in the general population. Methods and Results: Our systematic review of the literature published between January 1, 1966, and March 31, 2018 sought prospective, observational, cohort studies reporting summary-level outcome data about all-cause mortality in subjects with history of noncardiac/unexplained syncope compared with syncope-free participants. Adjusted hazard ratios were pooled through inverse variance random-effect meta-analysis to compute the summary effect size. Meta-regression models were performed to explore the effect of age, cardiovascular risk factors, or other potential confounders on the measured effect size. We identified four studies including 287 382 individuals (51.6% men; age, 64 ± 12 years): 38 843 with history of noncardiac/unexplained syncope and 248 539 without history of syncope. The average follow-up was 4.4 years. History of noncardiac/unexplained syncope was associated with higher all-cause mortality (pooled adjusted hazard ratio = 1.13; 95% confidence interval, 1.05 to 1.23). Meta-regression analysis showed a stronger positive relationship proportional to aging and increasing prevalence of diabetes and hypertension. Conclusions: This study-level meta-analysis showed that among older, diabetic and/or hypertensive individuals, history of noncardiac/unexplained syncope, even in the absence of an obvious cardiac etiology, is associated with higher all-cause mortality.</p>},
  author       = {Ricci, Fabrizio and Sutton, Richard and Palermi, Stefano and Tana, Claudio and Renda, Giulia and Gallina, Sabina and Melander, Olle and De Caterina, Raffaele and Fedorowski, Artur},
  issn         = {1045-3873},
  language     = {eng},
  number       = {12},
  pages        = {1641--1647},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Cardiovascular Electrophysiology},
  title        = {Prognostic significance of noncardiac syncope in the general population : A systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1111/jce.13715},
  doi          = {10.1111/jce.13715},
  volume       = {29},
  year         = {2018},
}