Gabrielli Luigi A, Castro Pablo F, Verdejo Hugo E, McNab Paul A, Llevaneras Silvana A, Mardonez José M, Corbalán Ramón L
Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Med Chil. 2008 Apr;136(4):442-50. Epub 2008 Jun 16.
Nearly 10% of patients with an actual acute coronary syndrome (ACS) are discharged with an inadequate diagnosis.
To select clinical and laboratory predictors to identify patients with a high likelihood of ACS in the Chest Pain Unit.
Prospective evaluation of patients consulting in a Chest Pain Unit of a University Hospital. Initial assessment was standardized and included evaluation of pain characteristics, electrocardiogram and Troponin I. Independent predictors of ACS were identified with a multiple logistic regression.
In a four years period, 1,168 patients aged 62+/-23 years (69% males), were studied. After initial evaluation, 62% of the patients were admitted to the hospital for further testing and in 71% of them, a definite diagnosis of ACS was made. No events were reported by patients directly discharged from the Chest Pain Unit. Independent predictors associated with a higher likelihood of ACS were an abnormal electrocardiogram at the initial evaluation (Odds ratio (OR) 5.37, 95% confidence intervals (CI) 3.61-7.99), two or more cardiovascular risk factors (OR 2.16, 95% CI 1.21-2.84), cervical irradiation of the pain (OR 1.84, 95% CI 1.25-2.69), age over 65 years (OR 1.73, 95% CI (1.32-2.27) and a Troponin I above the upper normal limit (OR: 5.68, 95% CI 3.72-8.29).
Simple clinical findings allow an appropriate identification of patients with a high likelihood of ACS without specialized methods for myocardial ischemia detection.
近10%的实际患有急性冠状动脉综合征（ACS）的患者出院时诊断不充分。
选择临床和实验室预测指标，以识别胸痛单元中ACS可能性高的患者。
对一家大学医院胸痛单元就诊的患者进行前瞻性评估。初始评估标准化，包括疼痛特征、心电图和肌钙蛋白I评估。通过多元逻辑回归确定ACS的独立预测指标。
在四年期间，研究了1168例年龄为62±23岁（69%为男性）的患者。初始评估后，62%的患者入院进一步检查，其中71%确诊为ACS。胸痛单元直接出院的患者未报告任何事件。与ACS可能性较高相关的独立预测指标为初始评估时心电图异常（比值比（OR）5.37，95%置信区间（CI）3.61 - 7.99）、两个或更多心血管危险因素（OR 2.16，95% CI 1.21 - 2.84）、疼痛的颈部放射痛（OR 1.84，95% CI 1.25 - 2.69）、年龄超过65岁（OR 1.73，95% CI（1.32 - 2.27））以及肌钙蛋白I高于正常上限（OR：5.68，95% CI 3.72 - 8.29）。
简单的临床检查结果可在无需专门心肌缺血检测方法的情况下，对ACS可能性高的患者进行适当识别。
