Herlitz Johan, Hansson Elisabeth, Ringvall Eva, Starke Mia, Karlson Björn W, Waagstein Lisbeth
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Am J Emerg Med. 2002 Nov;20(7):588-94. doi: 10.1053/ajem.2002.35461.
The purpose of this study was to evaluate the possibility to predict in the prehospital phase the occurrence of a life-threatening disease or death among ambulance transported patients with acute chest pain or other symptoms raising any suspicion of an acute coronary syndrome. All patients transported by ambulance during 3 months in the community of Göteborg because of symptoms raising any suspicion of an acute coronary syndrome were included in the study. In all, 930 transports (of 859 patients) fulfilled the inclusion criteria, of which 235 (25.3%) fulfilled the criteria for a life-threatening disease. The overall 30-day mortality was 8.8%, and the 1-year mortality was 18.0%. Independent predictors for a life-threatening disease were a low oxygen saturation on admission of the ambulance crew, patient being clammy on admission of the ambulance crew, a history of myocardial infarction and ST elevation and T-wave inversion on admission to the emergency department. Independent predictors for 30-day mortality were age greater than 70 years, symptoms of dyspnoea, a low oxygen saturation, hypotension and decreased consciousness on admission of the ambulance crew, and ST-depression on electrocardiogram (ECG) on admission to the emergency department. Predictors of 1 year mortality were age greater than 70 years, a history of myocardial infarction, symptoms of dyspnoea, a low oxygen saturation on admission of the ambulance crew and ST-depression, and no sinus rhythm on admission to the emergency department. Among patients with acute chest pain or other symptoms raising any suspicion of an acute coronary syndrome, factors associated with a life-threatening disease and death could be defined. Predictors for the risk of death during the first 30 days were age greater than 70 years, symptoms of dyspnoea, a low oxygen saturation, hypotension and decreased consciousness on admission of the ambulance crew, and ST-depression on ECG on admission to the emergency department.
本研究的目的是评估在院前阶段预测因急性胸痛或其他引发急性冠状动脉综合征怀疑症状而由救护车转运患者中发生危及生命疾病或死亡的可能性。在哥德堡社区3个月内因引发急性冠状动脉综合征怀疑症状而由救护车转运的所有患者均纳入本研究。总共930次转运（涉及859名患者）符合纳入标准，其中235次（25.3%）符合危及生命疾病的标准。总体30天死亡率为8.8%，1年死亡率为18.0%。危及生命疾病的独立预测因素为救护人员入院时低氧饱和度、救护人员入院时患者皮肤湿冷、心肌梗死病史、入院至急诊科时ST段抬高和T波倒置。30天死亡率的独立预测因素为年龄大于70岁、呼吸困难症状、低氧饱和度、低血压、救护人员入院时意识减退以及入院至急诊科时心电图（ECG）ST段压低。1年死亡率的预测因素为年龄大于70岁、心肌梗死病史、呼吸困难症状、救护人员入院时低氧饱和度和ST段压低以及入院至急诊科时无窦性心律。在有急性胸痛或其他引发急性冠状动脉综合征怀疑症状的患者中，可以确定与危及生命疾病和死亡相关的因素。前30天死亡风险的预测因素为年龄大于70岁、呼吸困难症状、低氧饱和度、低血压、救护人员入院时意识减退以及入院至急诊科时心电图ST段压低。
