Lorenzoni Roberto, Ebert Alberto Genovesi, Lattanzi Fabio, Orsini Enrico, Mazzoni Alessandra, Magnani Mirco, Barbieri Cristina, Rossi Marco, Mazzuoli Francesco
Division of Cardiovascular Diseases, Campo di Marte Hospital, Lucca, Italy.
J Cardiovasc Med (Hagerstown). 2006 Mar;7(3):203-9. doi: 10.2459/01.JCM.0000215274.78014.f6.
Chest pain is a frequent cause of medical admission to the emergency department and the main differential diagnosis is between coronary and non-coronary chest pain. We elaborated a computer protocol for the management of patients with chest pain.
The computer protocol was made of three sections according to clinical, electrocardiographic and biochemical data. Each section was coded by a letter indicating the probability of coronary chest pain for each section. The combination of the three letters formed a score string used to assign patients to four subgroups of overall probability of coronary chest pain (low, medium-low, medium-high, and high). Low-probability patients were discharged from the emergency department, whereas high-probability patients were admitted to the coronary care unit. The medium-probability patients underwent further evaluation by means of a stress test and were re-classified as having a final low probability (negative test) or high probability (positive test).
We evaluated 472 patients (mean age 64 years, range 18-97 years; 47% female). The incidence of coronary events in patients with low, medium-low, medium-high and high overall probability was 1.9, 12.8,13.5 and 68.0%, respectively (P < 0.05). The positive and negative predictive values of the protocol were 64.7 and 97.1%, respectively.
Our computer protocol represents a reliable method for the management of patients with chest pain and a non-diagnostic electrocardiogram.
胸痛是急诊科患者就医的常见原因，主要鉴别诊断在于冠状动脉性胸痛和非冠状动脉性胸痛。我们制定了一个用于胸痛患者管理的计算机程序。
该计算机程序根据临床、心电图和生化数据分为三个部分。每个部分由一个字母编码，表示该部分冠状动脉性胸痛的可能性。这三个字母的组合形成一个评分字符串，用于将患者分为冠状动脉性胸痛总体可能性的四个亚组（低、中低、中高和高）。低可能性患者从急诊科出院，而高可能性患者收入冠心病监护病房。中可能性患者通过负荷试验进行进一步评估，并重新分类为最终低可能性（试验阴性）或高可能性（试验阳性）。
我们评估了472例患者（平均年龄64岁，范围18 - 97岁；47%为女性）。低、中低、中高和高总体可能性患者的冠状动脉事件发生率分别为1.9%、12.8%、13.5%和68.0%（P < 0.05）。该程序的阳性和阴性预测值分别为64.7%和97.1%。
我们的计算机程序是一种用于胸痛且心电图无诊断意义患者管理的可靠方法。
