Incidence and prognosis of syncope
Incidence and prognosis of syncope
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DOI：
10.1056/nejmoa012407
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发表时间：
2002-09-19
影响因子：
158.5
通讯作者：
Levy, D
中科院分区：
文献类型：
--
作者：
Soteriades, ES;Evans, JC;Levy, D
背景：对于一般人群中晕厥的流行病学和预后知之甚少。方法：我们评估了 1971 年至 1998 年参加弗雷明汉心脏研究的女性和男性晕厥的发病率、具体原因和预后。结果：在 7814 名研究参与者中，平均随访 17 年，其中 822 人报告晕厥。首次报告晕厥的发生率为每 1000 人年 6.2 例。最常见的原因是血管迷走性（21.2%）、心脏性（9.5%）和直立性（9.4%）； 36.6% 的人原因不明。与没有晕厥的参与者相比，发生任何原因晕厥的参与者的多变量调整风险比为：任何原因死亡为 1.31（95% 置信区间，1.14 至 1.51）；心肌梗死或冠心病死亡为 1.27（95% 置信区间，0.99 至 1.64）；以及 1.06（95% 置信区间，0.77 至 1.64）。 1.45）致命或非致命中风。心源性晕厥参与者的相应风险比分别为 2.01（95% 置信区间，1.48 至 2.73）、2.66（95% 置信区间，1.69 至 4.19）和 2.01（95% 置信区间，1.06 至 3.80）。不明原因晕厥和神经性晕厥的参与者因任何原因死亡的风险增加，多变量调整后的风险比分别为 1.32（95% 置信区间，1.09 至 1.60）和 1.54（95% 置信区间，1.12 至 2.12）。血管迷走性（包括直立性和药物相关）晕厥不会增加心血管发病或死亡的风险。结论：心源性晕厥患者全因死亡和心血管事件的风险增加，不明原因晕厥患者全因死亡的风险增加。血管迷走性晕厥的预后似乎良好。
Background: Little is known about the epidemiology and prognosis of syncope in the general population.Methods: We evaluated the incidence, specific causes, and prognosis of syncope among women and men participating in the Framingham Heart Study from 1971 to 1998.Results: Of 7814 study participants followed for an average of 17 years, 822 reported syncope. The incidence of a first report of syncope was 6.2 per 1000 person-years. The most frequently identified causes were vasovagal (21.2 percent), cardiac (9.5 percent), and orthostatic (9.4 percent); for 36.6 percent the cause was unknown. The multivariable-adjusted hazard ratios among participants with syncope from any cause, as compared with those who did not have syncope, were 1.31 (95 percent confidence interval, 1.14 to 1.51) for death from any cause, 1.27 (95 percent confidence interval, 0.99 to 1.64) for myocardial infarction or death from coronary heart disease, and 1.06 (95 percent confidence interval, 0.77 to 1.45) for fatal or nonfatal stroke. The corresponding hazard ratios among participants with cardiac syncope were 2.01 (95 percent confidence interval, 1.48 to 2.73), 2.66 (95 percent confidence interval, 1.69 to 4.19), and 2.01 (95 percent confidence interval, 1.06 to 3.80). Participants with syncope of unknown cause and those with neurologic syncope had increased risks of death from any cause, with multivariable-adjusted hazard ratios of 1.32 (95 percent confidence interval, 1.09 to 1.60) and 1.54 (95 percent confidence interval, 1.12 to 2.12), respectively. There was no increased risk of cardiovascular morbidity or mortality associated with vasovagal (including orthostatic and medication-related) syncope.Conclusions: Persons with cardiac syncope are at increased risk for death from any cause and cardiovascular events, and persons with syncope of unknown cause are at increased risk for death from any cause. Vasovagal syncope appears to have a benign prognosis.