• Jennifer L White, Anna Marie Chang, Judd E Hollander, Erica Su, Robert E Weiss, Annick N Yagapen, Susan E Malveau, David H Adler, Aveh Bastani, Christopher W Baugh, Jeffrey M Caterino, Carol L Clark, Deborah B Diercks, Bret A Nicks, Daniel K Nishijima, Manish N Shah, Kirk A Stiffler, Alan B Storrow, Scott T Wilber, and Benjamin C Sun.
• Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America. Electronic address: Jennifer.white2@jefferson.edu.
• Am J Emerg Med. 2019 Apr 1; 37 (4): 685-689.

BackgroundSyncope is a common chief complaint in the ED, and the electrocardiogram (ECG) is a routine diagnostic tool in the evaluation of syncope. We assessed whether increasingly prolonged QTc intervals are associated with composite 30-day serious outcomes in older adults presenting to the ED with syncope.MethodsThis is a secondary analysis of a prospective, observational study at 11 EDs in adults 60 years or older who presented with syncope or near syncope. We excluded patients presenting without an ECG, measurement of QTc, non-sinus rhythm, bundle branch block or those without 30-day follow-up. We categorized QTc cutoffs into values of <451; 451-470; 471-500, and >500 ms. We determined the rate of composite 30-day serious outcomes including ED serious outcomes and 30-day arrhythmias not identified in ED.ResultsThe study cohort included 2609 patients. There were 1678 patients (64.3%) that had QTc intervals <451 ms; 544 (20.8%) were 451-470 ms; 302 (11.6%) were 471-500 ms, and 85 (3.3%) had intervals >500 ms. Composite 30-day serious outcomes was associated with increasingly prolonged QTc intervals (13.0%, 15.3%, 18.2%, 22.4%, p = 0.01), but this association did not persist in multivariate analysis.ConclusionsIn a cohort of older patients presenting with syncope, increased QTc interval was a marker of but was not independently predictive of composite 30-day serious outcomes.Copyright © 2018 Elsevier Inc. All rights reserved.

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