EGSYS Score - Syncope

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Clinical Use

Predict cardiac syncope in patients with unexplained syncope presenting to emergency department

More Info

EGSYS (Evaluation of Guidelines in SYncope Study) Score for syncope was derived from a prospective cohort study of 516 consecutive patients with unexplained syncope referred for evaluation in emergency department of 14 general hospitals.

Abnormal ECG and/or heart disease, palpitations before syncope, syncope during effort or in supine position, absence of autonomic prodromes and absence of predisposing and/or precipitating factors were found to be predictors of cardiac syncope. To each variable a score from +4 to -1 was assigned to the magnitude of regression coefficient.

Finding Points
Abnormal EKG† and/or heart disease‡ +3
Palpitations before syncope +4
Syncope during effort +3
Syncope in supine position +2
Autonomic prodromes -1
Predisposing and/or precipitating factors -1
 † Abnormal EKG – Sinus bradycardia, AV block >1st degree, BBB, acute or old MI, SVT or VT, left or right ventricular hypertrophy, ventricular preexcitation, long QT, or Brugada pattern.
‡ Heart disease – Ischemic heart disease, valvular dysfunction, myocardiopathies and congenital heart disease, previous diagnosis or clinical evidence of congestive heart failure, physical signs of structural heart disease
✧ Predisposing and/or precipitating factors – Warm or crowded place, prolonged orthostasis, fear/pain/other emotion


Likelihood for cardiac syncope and mortality rate at 21-24 months
EGSYS Likelihood for Cardiac Syncope Mortality at 21–24 months
≥3 Cardiac syncope likely (95% sensitive) 17%
<3 Cardiac syncope less likely 3%


A score ≥3 is considered the best discriminator for a diagnosis of cardiac syncope with a sensitivity of 95% and a specificity of 61%. This confers a PPV of 33% but a NPV of 99%.

Patients with a score ≥3  had a significantly higher mortality over an average follow-up of 614 days. Therefore, patients with a score ≥3 are recommended to be admitted to hospital for further work-up.


1. Del Rosso A, Ungar A, Maggi R, et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart. 2008;94(12):1620-6. Full text


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Developer: Sirikarn Napan, MD, FACC