Herlitz J, Karlson B W, Richter A, Strömbom U, Hjalmarson A
Department of Medicine I, Sahlgrenska Hospital, Göteborg, Sweden.
Clin Cardiol. 1992 Aug;15(8):570-6. doi: 10.1002/clc.4960150805.
In all 4,232 patients admitted to a single hospital during a 21-month period due to initially suspected acute myocardial infarction (AMI), the prognosis and risk factor pattern were related to whether patients had chest pain or not. Symptoms other than chest pain that raised a suspicion of AMI were mainly acute heart failure, arrhythmia, and loss of consciousness. In 377 patients (9%) symptoms other than chest pain raised an initial suspicion of AMI. These patients developed a confirmed infarction during the first three days in hospital with a similar frequency (22%) as compared with patients having chest pain (22%). However, patients with "other symptoms" had a one-year mortality of 28% versus 15% for chest pain patients (p less than 0.001). Patients with "other symptoms" more often died in association with ventricular fibrillation and less often in association with cardiogenic shock as compared with chest pain patients. Among the 921 patients who developed early AMI, 64 (7%) had symptoms other than chest pain. They had a one-year mortality of 48% versus 27% for chest pain patients (p less than 0.001). We conclude that in a nonselected group of patients hospitalized due to suspected AMI, those with symptoms other than chest pain have a one-year mortality, which is nearly twice that of patients with chest pain.
在一家医院21个月期间因最初疑似急性心肌梗死（AMI）而收治的4232例患者中，预后和危险因素模式与患者是否有胸痛有关。引发AMI怀疑的除胸痛外的症状主要是急性心力衰竭、心律失常和意识丧失。在377例患者（9%）中，除胸痛外的症状引发了对AMI的初步怀疑。这些患者在住院的头三天内发生确诊梗死的频率（22%）与有胸痛的患者（22%）相似。然而，有“其他症状”的患者一年死亡率为28%，而胸痛患者为15%（p<0.001）。与胸痛患者相比，有“其他症状”的患者更常死于室颤，而较少死于心源性休克。在921例发生早期AMI的患者中，64例（7%）有除胸痛外的症状。他们的一年死亡率为48%，而胸痛患者为27%（p<0.001）。我们得出结论，在因疑似AMI住院的非选择性患者组中，有除胸痛外症状的患者一年死亡率几乎是有胸痛患者的两倍。
