GENDER DIFFERENCES IN PRESENTATION, MANAGEMENT, AND CARDIAC EVENT-FREE SURVIVAL IN PATIENTS WITH SYNCOPE

In a MEDLINE search of published English studies (1966 to 1996), no pr ior study was identified that examined gender-based differences in the management and prognosis of patients admitted with syncope. We studie d 109 consecutive patients (48 women) admitted with syncope at the Mas sachusetts General Hospital (1989 to 1990). All patients underwent Hol ter monitoring, signal-averaged electrocardiography, and echocardiogra phy according to study protocol. Follow-up was 100% complete (10 +/- 4 months). Women were older (74 +/- 2 vs 66 +/- 2 years, p < 0.01) and less likely to have premonitory symptoms when compared with men (46% v s 66%, p < 0.05). A greater proportion of men had left ventricular eje ction fractions of < 0.40 (18% vs 0%, p < 0.01), abnormal signal-avera ged electrocardiograms (28% vs 8%, p < 0.01), and a cardiac cause for syncope (49% vs 25%, p < 0.01). Although referral for diagnostic elect rophysiologic testing was > 3 times as frequent for men compared with women (20% of men vs 6% of women, p < 0.05), this difference wets not significant after adjustment for age, ventricular arrhythmia, and refe rral for coronary angiography. During follow-up, 21% of men versus 6% of women (p < 0.05) had cardiac events (recurrent syncope, myocardial infarction, or sudden death). Cardiac event-free survival rates were w orse for men (p = 0.045). Thus, we have identified gender-based differ ences in the clinical presentation of syncope for hospital admission. left ventricular dysfunction and an abnormal signal-averaged electroca rdiogram occur more frequently in men. Men are more likely to have car diac syncope and worse cardiac event-free survival when compared with women. (C) 1997 by Excerpta Medico, Inc.