Gorelik Oleg, Almoznino-Sarafian Dorit, Yarovoi Israel, Alon Irena, Shteinshnaider Miriam, Chachashvily Shulamit, Modai David, Cohen Natan
Department of Internal Medicine 'F', Assaf Harofeh Medical Center, Zerifin, Israel.
Coron Artery Dis. 2006 Feb;17(1):15-21. doi: 10.1097/00019501-200602000-00003.
Improving risk stratification of patients experiencing acute chest pain with non-revealing electrocardiogram and cardiac biomarkers could reduce missed acute coronary syndrome and avoid unnecessary hospitalization.
We assessed the ability of situational, circumstantial, and other patient-related variables in predicting acute coronary syndrome in 921 consecutive patients randomly admitted to this medical department with chest pain of possible coronary origin. A reference group comprised 107 patients referred promptly to the coronary care unit with acute myocardial infarction.
Acute coronary syndrome eventually developed in 219 (23.7%) patients. Age and proportions of male patients and those with diabetes, which were significantly lower in the heterogeneous chest pain group than in the reference group, did not differ when re-evaluation was performed between the latter group and the subgroup of patients who eventually developed acute coronary syndrome. Overweight and a family history of premature coronary artery disease remained significantly higher in the reference group, while prevalence of pre-existing coronary artery disease, previous coronary angiography, and coronary intervention remained significantly lower. Variables most significantly predictive of acute coronary syndrome resulted: pre-existing coronary artery disease [odds ratio (OR) 3.2; 95% confidence interval (CI) 2.17-4.71; P<0.001), older age (OR 1.35; 95% CI 1.17-1.57; P<0.001), male sex (OR 1.77; 95% CI 1.19-2.61; P=0.004), diabetes (OR 1.6; 95% CI 1.11-2.32; P=0.01), self-initiation of pain relief treatment before seeking medical help (OR 1.54; 95% CI 1.07-2.23; P=0.02), and conviction that hospitalization for acute coronary disease was mandatory (OR 1.46; 95% CI 1.03-2.07; P=0.03).
Easily obtainable patient-related variables might improve risk stratification and assist physicians to decide on policy in the emergency department and upon hospitalization.
改善急性胸痛且心电图和心脏生物标志物无异常患者的风险分层，可减少急性冠状动脉综合征漏诊并避免不必要的住院治疗。
我们评估了情景、环境及其他患者相关变量对921例因可能源于冠状动脉的胸痛而随机入住本内科的连续患者发生急性冠状动脉综合征的预测能力。一个参照组由107例因急性心肌梗死而迅速转入冠心病监护病房的患者组成。
最终219例（23.7%）患者发生急性冠状动脉综合征。在重新评估时，胸痛异质性组的年龄、男性患者比例以及糖尿病患者比例显著低于参照组，但在参照组与最终发生急性冠状动脉综合征的患者亚组之间并无差异。参照组超重及早发冠状动脉疾病家族史的比例仍显著更高，而既往冠状动脉疾病、既往冠状动脉造影及冠状动脉介入治疗的患病率仍显著更低。最能显著预测急性冠状动脉综合征的变量如下：既往冠状动脉疾病[比值比（OR）3.2；95%置信区间（CI）2.17 - 4.71；P<0.001]、年龄较大（OR 1.35；95% CI 1.17 - 1.57；P<0.001）、男性（OR 1.77；95% CI 1.19 - 2.61；P = 0.004）、糖尿病（OR 1.6；95% CI 1.11 - 2.32；P = 0.01）、在寻求医疗帮助前自行开始缓解疼痛治疗（OR 1.54；95% CI 1.07 - 2.23；P = 0.02）以及坚信必须因急性冠状动脉疾病住院治疗（OR 1.46；95% CI 1.03 - 2.07；P = 0.03）。
易于获取的患者相关变量可能改善风险分层，并协助医生在急诊科及住院时做出决策。
