Bertini G, Rostagno C, Taddei T, Lazzerini S, Taiti A, Casolo G, Russo L
Clinica Medica I, University of Florence, Italy.
J Emerg Med. 1991;9 Suppl 1:57-63. doi: 10.1016/0736-4679(91)90589-8.
This study was designed to assess the accuracy of a diagnostic protocol of the mobile coronary care unit (MCCU) of Florence for acute chest discomfort. During 1986, 706 patients with chest pain were seen by the MCCU. Of these, 324 of 376 (95.2%) of those hospitalized and 247 of 324 (76.2%) of the nonhospitalized patients were entered in the study. The MCCU diagnosis of acute myocardial infarction (AMI) was confirmed in 120 patients (80.3%). A false positive diagnosis of AMI was made in 27 patients (6.9%), while in 37 patients AMI was not diagnosed at the first MCCU clinical examination (false negative). The sensitivity in the diagnosis of AMI was 80.5%, the specificity 91.8%, and the diagnostic accuracy 89.1%. In the recognition of acute coronary syndromes (AMI + unstable angina), sensitivity and specificity were, respectively, 94.0% and 94.4%. The protocol of the Florence MCCU provides high accuracy in the diagnosis of AMI and acute coronary insufficiency; close adherence to the protocol can decrease the number and the costs of undue hospital admissions while protecting the safety of patients.
本研究旨在评估佛罗伦萨移动冠心病监护病房（MCCU）针对急性胸部不适的诊断方案的准确性。1986年期间，MCCU诊治了706例胸痛患者。其中，376例住院患者中的324例（95.2%）以及324例非住院患者中的247例（76.2%）纳入了研究。120例患者（80.3%）的MCCU急性心肌梗死（AMI）诊断得到证实。27例患者（6.9%）被误诊为AMI（假阳性），而37例患者在首次MCCU临床检查时未被诊断为AMI（假阴性）。AMI诊断的敏感性为80.5%，特异性为91.8%，诊断准确性为89.1%。在识别急性冠脉综合征（AMI+不稳定型心绞痛）方面，敏感性和特异性分别为94.0%和94.4%。佛罗伦萨MCCU的诊断方案在AMI和急性冠脉功能不全的诊断中具有很高的准确性；严格遵守该方案可以减少不必要的住院次数和费用，同时保障患者的安全。
