Lindsell Christopher J, Anantharaman Venkataraman, Diercks Deborah, Han Jin Ho, Hoekstra James W, Hollander Judd E, Kirk J Douglas, Lim Swee-Han, Peacock W Frank, Tiffany Brian, Wilke Eric K, Gibler W Brian, Pollack Charles V
Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267-0769, USA.
Ann Emerg Med. 2006 Dec;48(6):666-77, 677.e1-9. doi: 10.1016/j.annemergmed.2006.08.005. Epub 2006 Oct 2.
Observational studies of well-described patient populations presenting to emergency departments (EDs) with suspicion of acute coronary syndrome are necessary to understand the relationships between patients' signs and symptoms, cardiac risk profile, test results, practice patterns, and outcomes. We describe the methods for data collection and the ED population enrolled in a multicenter registry of patients with chest pain.
Patients older than 18 years, presenting to one of 8 EDs in the United States or 1 ED in Singapore, and with possible acute coronary syndrome were enrolled in the Internet Tracking Registry of Acute Coronary Syndromes between June 1999 and August 2001. Prospective data, including presenting signs and symptoms, ECG findings, and the ED physician's initial impression of risk, were systematically collected. Medical record review or daily follow-up was used to obtain cardiac biomarker results, invasive and noninvasive testing, treatments, procedures, and inhospital outcomes. Thirty-day outcomes were determined by telephone follow-up and medical record review.
The registry includes 15,608 patients, with 17,713 visits. Chest pain was the chief complaint in 71% of visits. The ECG was diagnostic of ischemia or infarction in 10.1% and positive cardiac biomarkers were observed in 10% of visits. Forty-three percent of patients were sent home directly from the ED. Of admitted patients, 5% died by 30 days, and 3% had documented coronary artery disease or had undergone percutaneous coronary intervention or coronary artery bypass grafting within 30 days. For patients discharged directly from the ED, 0.4% died or had a documented myocardial infarction within 30 days. Coronary artery bypass graft surgery, percutaneous coronary intervention, or a diagnosis of coronary artery disease was found in 0.5% of discharged patients.
A unique description of undifferentiated ED chest pain patients with suspected acute coronary syndrome is provided. The data set can be used to generate and explore hypotheses to improve understanding of the complex relationships between presentation, treatment, testing, intervention and outcomes.
对因疑似急性冠状动脉综合征而前往急诊科（ED）就诊的详细描述的患者群体进行观察性研究，对于理解患者的体征和症状、心脏风险状况、检查结果、诊疗模式及预后之间的关系很有必要。我们描述了胸痛患者多中心注册研究中数据收集的方法以及纳入的急诊科患者群体情况。
1999年6月至2001年8月期间，年龄大于18岁、前往美国8家急诊科之一或新加坡1家急诊科就诊且可能患有急性冠状动脉综合征的患者被纳入急性冠状动脉综合征互联网追踪注册研究。系统收集了前瞻性数据，包括就诊时的体征和症状、心电图表现以及急诊科医生对风险的初步判断。通过病历审查或每日随访获取心脏生物标志物结果、有创和无创检查、治疗、操作及住院结局。通过电话随访和病历审查确定30天结局。
该注册研究纳入了15608例患者，就诊17713次。71%的就诊以胸痛为主要诉求。心电图诊断为缺血或梗死的占10.1%，10%的就诊观察到心脏生物标志物阳性。43%的患者直接从急诊科出院。在入院患者中，5%在30天内死亡，3%在30天内被记录患有冠状动脉疾病或接受了经皮冠状动脉介入治疗或冠状动脉旁路移植术。对于直接从急诊科出院的患者，0.4%在30天内死亡或发生有记录的心肌梗死。0.5%的出院患者接受了冠状动脉旁路移植手术、经皮冠状动脉介入治疗或被诊断为冠状动脉疾病。
提供了对疑似急性冠状动脉综合征的未分化急诊科胸痛患者的独特描述。该数据集可用于生成和探索假设，以增进对表现、治疗、检查、干预和结局之间复杂关系的理解。
