Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Neth Heart J. 2008 Oct;16(10):325-31. doi: 10.1007/BF03086173.
BACKGROUND/OBJECTIVES.: A rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is mandatory for optimal treatment. However, a small proportion of patients with suspected STEMI suffer from other conditions. Although case reports have described these conditions, a contemporary systematic analysis is lacking. We report the incidence, clinical characteristics and outcome of patients with suspected STEMI referred for primary percutaneous coronary intervention (PCI) with a final diagnosis other than STEMI. METHODS.: From January 2004 to July 2005, 820 consecutive patients were included with suspected STEMI who were referred for primary PCI to a university medical centre, based on a predefined protocol. Clinical characteristics, final diagnosis and outcome were obtained from patient charts and databases. RESULTS.: In 19 patients (2.3%), a final diagnosis other than myocardial infarction was established: coronary aneurysm (n=1), (myo)pericarditis (n=5), cardiomyopathy (n=2), Brugada syndrome (n=1), aortic stenosis (n=1), aortic dissection (n=3), subarachnoidal haemorrhage (n=2), pneumonia (n=1), chronic obstructive pulmonary disease (n=1), mediastinal tumour (n=1), and peritonitis after recent abdominal surgery (n=1). These patients less often reported previous symptoms of angina (p<0.001), smoking (p<0.05) and a positive family history of cardiovascular diseases (p<0.05) than STEMI patients. Mortality at 30 days was 16%. CONCLUSION.: A 2.3% incidence of conditions mimicking STEMI was found in patients referred for primary PCI. A high clinical suspicion of conditions mimicking STEMI remains necessary. (Neth Heart J 2008;16:325-31.).
背景/目的：快速诊断 ST 段抬高型心肌梗死（STEMI）对于优化治疗至关重要。然而，一小部分疑似 STEMI 的患者可能患有其他疾病。尽管已有病例报告描述了这些疾病，但目前仍缺乏对这些疾病的系统分析。我们报告了因疑似 STEMI 而接受直接经皮冠状动脉介入治疗（PCI），但最终诊断非 STEMI 的患者的发病率、临床特征和结局。方法：2004 年 1 月至 2005 年 7 月，根据既定方案，我们连续纳入了 820 例疑似 STEMI 并接受直接 PCI 的患者。从病历和数据库中获取患者的临床特征、最终诊断和结局。结果：在 19 例（2.3%）患者中，最终诊断非心肌梗死：冠状动脉瘤（n=1）、（心肌）心包炎（n=5）、心肌病（n=2）、Brugada 综合征（n=1）、主动脉瓣狭窄（n=1）、主动脉夹层（n=3）、蛛网膜下腔出血（n=2）、肺炎（n=1）、慢性阻塞性肺疾病（n=1）、纵隔肿瘤（n=1）和近期腹部手术后腹膜炎（n=1）。这些患者较 STEMI 患者更常报告无既往心绞痛症状（p<0.001）、吸烟（p<0.05）和心血管疾病阳性家族史（p<0.05）。30 天死亡率为 16%。结论：我们发现因疑似 STEMI 而接受直接 PCI 的患者中有 2.3%的发病率为类似于 STEMI 的疾病。对类似于 STEMI 的疾病保持高度临床怀疑仍然是必要的。（荷兰心脏杂志 2008；16：325-31）。
