Relative utility of serum troponin and the OESIL score in syncope

To investigate the utility of both a random troponin T level taken greater than 4 h after a syncopal event and the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score in predicting outcome post syncope.

We prospectively enrolled 113 adult patients who presented to our ED after a syncopal event. Each patient had a troponin T level taken at least 4 h after the event. The relevant history of the syncope, background medical history and ECG were collected at presentation. Patients were followed up via telephone after 3-6 months and medical records were also examined. The OESIL risk score was calculated for each patient and the predictive value of both the troponin T and OESIL score were analysed for their utility post syncope.

Data were analysed for 100 patients. Twenty percent were believed to have a cardiac cause for their syncope. An elevated troponin T level was found to be highly specific (0.99, 95% confidence interval [CI] 0.96-1.0) for adverse cardiac outcome, but with a very low sensitivity (0.13, 95% CI 0-0.3). The OESIL risk score was found to be predictive of an adverse cardiac outcome (receiver-operating characteristic [ROC] 0.73, 95% CI 0.63-0.84) and return to normal function (ROC 0.74, 95% CI 0.63-0.86).

A normal serum troponin T has a poor negative predictive value for adverse cardiac outcomes following syncope. A simple risk stratification system, such as the OESIL score, can predict those patients most at risk after a syncopal episode.