{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:09:51Z","timestamp":1788822591068,"version":"build-2803163510"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The prognostic significance of syncope in patients with acute pulmonary embolism (PE) remains uncertain. We assessed its association with early outcomes and explored whether distinct clinical phenotypes could be identified within this group.<\/jats:p>\n                  <jats:p>We analyzed a prospectively collected single-center cohort of patients with confirmed symptomatic PE diagnosed between 2010 and 2025, grouped by syncope at presentation. The primary outcome was a 30-day composite of all-cause mortality, major bleeding, and recurrent venous thromboembolism. Associations were estimated using inverse probability of exposure weighting. Estimand A balanced baseline confounders, whereas Estimand B additionally balanced measured markers of acute severity. Within the syncope subgroup, exploratory clustering used 13 baseline clinical variables.<\/jats:p>\n                  <jats:p>Among 2,331 patients with PE, 329 (14.1%) presented with syncope. Under Estimand A, syncope was associated with a 14.0-percentage-point higher risk of the composite outcome (95% confidence interval [CI]: 9.0\u201319.6; risk ratio [RR]: 2.71, 95% CI: 2.02\u20133.52). Under Estimand B, the association was substantially attenuated, with a risk difference of 5.2 percentage points (95% CI: \u2212\u20090.2 to 10.6; RR: 1.54, 95% CI: 0.98\u20132.19). A similar attenuation was observed for all-cause mortality and major bleeding. Exploratory clustering identified four phenotypes, none of which met the prespecified criteria for internal stability.<\/jats:p>\n                  <jats:p>In acute PE, syncope identifies patients at higher risk of early adverse outcomes. This association was substantially attenuated after accounting for measured acute severity, suggesting that syncope mainly marks a more severe initial presentation rather than carrying prognostic information independent of severity.<\/jats:p>","DOI":"10.1055\/a-2949-8251","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:00:56Z","timestamp":1788822056000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical Characteristics and Early Outcomes of Acute Pulmonary Embolism Presenting with Syncope"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8627-304X","authenticated-orcid":false,"given":"Marina","family":"L\u00f3pez-Rubio","sequence":"additional","affiliation":[{"name":"Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"],"department":["Department of Internal Medicine, Venous Thromboembolism Unit"]},{"name":"School of Medicine, Universidad Complutense de Madrid, Spain","place":["Madrid"],"department":["Department of Medicine"]},{"name":"Sanitary Research Institute Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4135-4883","authenticated-orcid":false,"given":"Victor Manuel","family":"Mart\u00ednez-Castilla","sequence":"additional","affiliation":[{"name":"Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"],"department":["Department of Internal Medicine, Venous Thromboembolism Unit"]},{"name":"School of Medicine, Universidad Complutense de Madrid, Spain","place":["Madrid"],"department":["Department of Medicine"]},{"name":"Sanitary Research Institute Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Cobo-Bustamante","sequence":"additional","affiliation":[{"name":"Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"],"department":["Department of Internal Medicine, Venous Thromboembolism Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Sanz-Tejeiro","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad Complutense de Madrid, Spain","place":["Madrid"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5492-7061","authenticated-orcid":false,"given":"Rub\u00e9n","family":"Alonso-Beato","sequence":"additional","affiliation":[{"name":"Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"],"department":["Department of Internal Medicine, Venous Thromboembolism Unit"]},{"name":"School of Medicine, Universidad Complutense de Madrid, Spain","place":["Madrid"],"department":["Department of Medicine"]},{"name":"Sanitary Research Institute Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"Ordieres-Ortega","sequence":"additional","affiliation":[{"name":"Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"],"department":["Department of Internal Medicine, Venous Thromboembolism Unit"]},{"name":"School of Medicine, Universidad Complutense de Madrid, Spain","place":["Madrid"],"department":["Department of Medicine"]},{"name":"Sanitary Research Institute Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crhistian-Mario","family":"Oblitas","sequence":"additional","affiliation":[{"name":"Complejo Hospitalario Universitario de Santiago de Compostela, Instituto de Investigaci\u00f3n Sanitaria de Santiago (IDIS), Spain","place":["Santiago de Compostela, A Coru\u00f1a"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Antonio","family":"\u00c1lvarez-Sala Walther","sequence":"additional","affiliation":[{"name":"Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"],"department":["Department of Internal Medicine, Venous Thromboembolism Unit"]},{"name":"School of Medicine, Universidad Complutense de Madrid, Spain","place":["Madrid"],"department":["Department of Medicine"]},{"name":"Sanitary Research Institute Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Galeano-Valle","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad Complutense de Madrid, Spain","place":["Madrid"],"department":["Department of Medicine"]},{"name":"Sanitary Research Institute Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]},{"name":"Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3096-4711","authenticated-orcid":false,"given":"Pablo","family":"Demelo-Rodriguez","sequence":"additional","affiliation":[{"name":"Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"],"department":["Department of Internal Medicine, Venous Thromboembolism Unit"]},{"name":"School of Medicine, Universidad Complutense de Madrid, Spain","place":["Madrid"],"department":["Department of Medicine"]},{"name":"Sanitary Research Institute Gregorio Mara\u00f1\u00f3n, Spain","place":["Madrid"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.hfc.2020.03.004","article-title":"Pulmonary embolism: a practical guide for the busy 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A retrospective review","volume":"9","author":"U Iqbal","year":"2017","journal-title":"J Clin Med Res"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1186\/s12890-025-03710-0","article-title":"Prognosis of pulmonary embolism associated with syncope: a prospective cohort with the pulmonary embolism registry of Bogodogo university hospital\/Burkina Faso","volume":"25","author":"T AA Seghda","year":"2025","journal-title":"BMC Pulm Med"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ejim.2018.04.004","article-title":"Impact of syncope and pre-syncope on short-term mortality in patients with acute pulmonary embolism","volume":"54","author":"L Roncon","year":"2018","journal-title":"Eur J Intern Med"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.annemergmed.2020.03.026","article-title":"The prognostic value of syncope on mortality in patients with pulmonary embolism: a systematic review and meta-analysis","volume":"76","author":"M A de Winter","year":"2020","journal-title":"Ann Emerg Med"},{"issue":"10","key":"ref20","doi-asserted-by":"crossref","first-page":"e13836","DOI":"10.1111\/eci.13836","article-title":"Syncope predicts major bleeding events in patients with pulmonary embolism","volume":"52","author":"J Auer","year":"2022","journal-title":"Eur J Clin Invest"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"13191","DOI":"10.1038\/s41598-020-69925-9","article-title":"Comparative assessment of genetic diversity matrices and clustering methods in white Guinea yam (Dioscorea rotundata) based on morphological and molecular markers","volume":"10","author":"K Darkwa","year":"2020","journal-title":"Sci Rep"}],"container-title":["Thrombosis and Haemostasis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2949-8251.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:01:02Z","timestamp":1788822062000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2949-8251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":21,"URL":"https:\/\/doi.org\/10.1055\/a-2949-8251","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0340-6245","2567-689X"],"issn-type":[{"value":"0340-6245","type":"print"},{"value":"2567-689X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]}}}