Herlitz J, Karlson B W, Bång A, Lindqvist J
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Eur J Emerg Med. 2000 Sep;7(3):195-200. doi: 10.1097/00063110-200009000-00006.
The aim of this study was to describe the characteristics and long-term outcome for patients suffering from acute chest pain in relation to whether or not they were transported to hospital by ambulance. All patients with acute chest pain who were admitted over a 21-month period to the emergency department at Sahlgrenska Hospital in Göteborg with symptoms of acute chest pain were included in the study. Consecutive patients were prospectively registered and followed with regard to mortality and morbidity over 5 years. In all, 4270 patients took part in the evaluation, of whom 1445 (34%) were transported by ambulance. Patients transported by ambulance were older (p < 0.0001) and had a higher prevalence of previous myocardial infarction, angina pectoris, hypertension, diabetes mellitus, and congestive heart failure (p < 0.0001 for all) than the others. They more frequently developed acute myocardial infarction (28% vs. 11%; p < 0.0001) and there was a final diagnosis of either confirmed or possible myocardial infarction/ischaemia in 69% compared with 38% for patients not transported by ambulance (p < 0.0001). The 5-year mortality among ambulance-transported patients was 41% vs. 16% among those who were not (p < 0.0001). When correcting for dissimilarities at baseline including final diagnosis the adjusted risk ratio for death among ambulance transported patients was 1.44 (95% confidence limit 1.26-1.65). However, we did not correct for severe non-cardiac diseases. It is concluded that among patients admitted to the emergency department with acute chest pain, those transported by ambulance had a much higher mortality during the subsequent 5 years than those who were not transported by ambulance. This was not entirely explained by observed differences at baseline. This information should be considered when ambulance organizations are being constructed.
本研究旨在描述急性胸痛患者的特征及长期预后，并探讨其与是否由救护车送往医院之间的关系。所有在21个月期间因急性胸痛症状入住哥德堡萨尔格伦斯卡医院急诊科的患者均纳入本研究。对连续的患者进行前瞻性登记，并随访其5年的死亡率和发病率。共有4270名患者参与评估，其中1445名（34%）由救护车运送。与其他患者相比，由救护车运送的患者年龄更大（p<0.0001），既往心肌梗死、心绞痛、高血压、糖尿病和充血性心力衰竭的患病率更高（所有p值均<0.0001）。他们更易发生急性心肌梗死（28%对11%；p<0.0001），最终确诊或可能诊断为心肌梗死/缺血的比例为69%，而非救护车运送患者的这一比例为38%（p<0.0001）。救护车运送患者的5年死亡率为41%，未由救护车运送患者的死亡率为16%（p<0.0001）。在校正包括最终诊断在内的基线差异后，救护车运送患者的死亡调整风险比为1.44（95%置信区间1.26 - 1.65）。然而，我们未对严重非心脏疾病进行校正。结论是，在因急性胸痛入住急诊科的患者中，由救护车运送的患者在随后5年的死亡率远高于未由救护车运送的患者。这不能完全由基线观察到的差异来解释。在构建救护车组织时应考虑这一信息。
