运动试验在因急性胸痛前来急诊科的特定患者中的应用价值。
Usefulness of exercise test in selected patients coming to the emergency department for acute chest pain.
作者信息
Macor Franco, Cassin Matteo, Pitzorno Cristina, Dall'Armellina Erica, Carniel Elisa, Marcianò Fortunato, Dametto Ermanno, Bitto Sandro, Martin Giovanni, Antonini-Canterin Francesco, Cervesato Eugenio, Burelli Claudio, Nicolosi Gian Luigi
机构信息
Cardiology Unit, S. Maria degli Angeli Hospital, Pordenone, Italy.
出版信息
Ital Heart J. 2003 Feb;4(2):92-8.
BACKGROUND
The management of patients with acute chest pain is a common and difficult challenge for clinicians. In our emergency department (ED) a systematic protocol that involves the use of the exercise test for the management of patients with chest pain of suspected cardiac origin is presently running. The aim of the present study was to evaluate the feasibility of such a test in this setting, in terms of the safety and satisfactory follow-up of these patients discharged home.
METHODS
Patients with chest pain lasting < or = 24 hours, aged > 18 years, without a history of trauma or of any other evident medical cause of chest pain and without high-risk characteristics were included in the present study. These patients, defined as low-risk patients for acute coronary events on admission, were evaluated in the ED area and submitted to serial ECG and blood sampling for the determination of the creatine kinase-MB mass and troponin I serum levels on admission and at 6 and 12 hours after admission. A symptom-limited maximal exercise was performed in the patients with a negative clinical observation and typical chest pain or atypical chest pain but multiple coronary risk factors.
RESULTS
In the year 2000, 1370 patients were evaluated in the ED for chest pain. In 150 (11%) an exercise test was performed. The test was positive in 24 patients (16%). The criteria for a positive test were only clinical in 3 patients, only ECG in 13 patients, and both in 8 patients. Inconclusive tests were observed in 27 patients (18%) and the test was negative in 99 patients (66%). There were no complications during the exercise test. At a median follow-up of 237 days (range 11-443 days), 11 clinical events were recorded (4 acute coronary syndromes and 7 revascularization procedures). Patients with a non-negative exercise test had a significantly shorter event-free survival (p < 0.005).
CONCLUSIONS
The exercise test performed in selected patients coming to the ED with acute chest pain is safe and useful for further risk assessment.
背景
对急性胸痛患者的管理是临床医生常见且棘手的挑战。在我们的急诊科，目前正在实施一项系统方案，该方案涉及使用运动试验来管理疑似心脏源性胸痛的患者。本研究的目的是从这些出院回家患者的安全性和满意随访情况方面，评估在这种情况下该试验的可行性。
方法
本研究纳入了胸痛持续时间≤24小时、年龄>18岁、无创伤史或任何其他明显的胸痛医学病因且无高危特征的患者。这些患者在入院时被定义为急性冠状动脉事件的低风险患者，在急诊科区域接受评估，并在入院时、入院后6小时和12小时进行系列心电图检查和血液采样，以测定肌酸激酶-MB质量和肌钙蛋白I血清水平。对临床观察阴性且有典型胸痛或非典型胸痛但有多个冠状动脉危险因素的患者进行症状限制性最大运动试验。
结果
2000年，有1370例患者在急诊科接受胸痛评估。其中150例（11%）进行了运动试验。试验阳性的有24例（16%）。试验阳性标准仅为临床标准的有3例，仅为心电图标准的有13例，两者均符合的有8例。27例（18%）试验结果不明确，99例（66%）试验结果为阴性。运动试验期间无并发症发生。中位随访237天（范围11 - 443天）时，记录到11例临床事件（4例急性冠状动脉综合征和7例血运重建手术）。运动试验结果为非阴性的患者无事件生存期明显较短（p<0.005）。
结论
对因急性胸痛前来急诊科的选定患者进行运动试验，对于进一步的风险评估是安全且有用的。
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