Study Finds Pulmonary Embolus Rarely the Cause of Syncope Interview with:
Giorgio Costantino MD

Dipartimento di Medicina Interna
Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda
Ospedale Maggiore Policlinico
Università degli Studi di Milano
Milan, Italy What is the background for this study?

Response: Syncope is a common symptom that occurs in one in four people during their lifetime. Pulmonary embolism (PE) has long been recognized as an important and serious cause of syncope. PE has always been estimated a rare cause of syncope, present in less than 1.5% of patients. A recent study (PESIT), aiming at evaluating PE prevalence using a standardized algorithm in hospitalized patients after a first syncope episode, found a prevalence of PE as high as 17% in hospitalized patients. This means that patients with a first episode of syncope should be investigated with a standard diagnostic algorithm to exclude PE.

However, many patients might go through useless and potentially harmful tests, such as computed tomography pulmonary angiogram. What are the main findings?

Response: We analyzed 1,5 million of people with syncope from five different administrative databases from US, Canada, Denmark and Italy and found that PE is very rare in patients with syncope (less than 1%). What should readers take away from your report?

Response: We think that people with syncope should not be routinely assessed to exclude PE. Indeed, adopting a standardized algorithm in each patient might be harmful for the patients (in terms of radiation and false positive results) and increase costs. What recommendations do you have for future research as a result of this work? 

Response:  Future studies should clarify what patients are at increased risk of PE and need to be screened for it.


Costantino G, Ruwald MH, Quinn J, Camargo CA, Dalgaard F, Gislason G, Goto T, Hasegawa K, Kaul P, Montano N, Numé A, Russo A, Sheldon R, Solbiati M, Sun B, Casazza G. Prevalence of Pulmonary Embolism in Patients With Syncope. JAMA Intern Med. Published online January 29, 2018. doi:10.1001/jamainternmed.2017.8175

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Last Updated on January 31, 2018 by Marie Benz MD FAAD