Dipartimento dell'Emergenza, Presidio Ospedaliero Morgagni-Pierantoni, Azienda Unità Sanitaria Locale di Forlì, I-47100 Forlì, Italy.
Am J Emerg Med. 2012 Jan;30(1):61-7. doi: 10.1016/j.ajem.2010.09.022. Epub 2010 Oct 29.
Subjects with chest pain and a negative diagnostic workup constitute a problem for emergency physicians. We tested the usefulness of clinical variables in predicting 30-day and 6-month outcome in subjects with chest pain of undifferentiated origin after a negative workup.
Chest pain of undifferentiated origin was diagnosed by negative first-line (serial electrocardiograms, troponins assays, and 12- to 24-hour observation) and second-line evaluation (echocardiography, exercise tolerance test, stress scintigraphy, stress echocardiography, coronary angiography). Thirty-day and 6-month outcomes were considered unfavorable in the presence of any of the following: death, acute coronary syndrome, need for urgent coronary revascularization. The variables considered for risk stratification were age, sex, smoking, family history of coronary artery disease, presence of hypertension, high cholesterol levels, diabetes, chronic renal failure, cerebral vascular disease, and history of acute coronary syndrome, percutaneous transluminal angioplasty (PTA), coronary artery by pass graft, and heart failure.
Five items (diabetes, chronic renal failure, history of PTA or bypass, history of heart failure) were associated with 30-day unfavorable outcome (31 events/1262 cases; 2.5%). The receiver operating characteristic area of the selected items was 0.726 (95% confidence interval [CI], 0.654-0.798); sensitivity was 90.3% (73.1-95.8) and specificity was 54.8% (52.0-57.6). A similar panel of items (older age, diabetes, chronic renal failure, history of PTA) predicted an unfavorable 6-month outcome (90 subjects [7.1%], with lower accuracy (receiver operating characteristic area, 0.610 [95% CI, 0.594-0.627, P < .05]; sensitivity, 98.9% [95% CI, 93.1-99.6]; specificity, 21.6% [95% CI, 19.4-23.9]).
In subjects with chest pain of undifferentiated origin, the risk of unfavorable outcome cannot be accurately predicted by the selected clinical items.
对于急诊医生来说，胸痛且诊断性检查为阴性的患者是一个问题。我们检测了临床变量在预测经阴性检查后病因不明胸痛患者 30 天和 6 个月结局方面的作用。
病因不明胸痛通过一线（连续心电图、肌钙蛋白检测和 12-24 小时观察）和二线评估（超声心动图、运动耐量试验、应激闪烁扫描、应激超声心动图、冠状动脉造影）阴性检查来诊断。如果出现以下任何一种情况，则认为 30 天和 6 个月结局不佳：死亡、急性冠状动脉综合征、需要紧急冠状动脉血运重建。用于风险分层的变量包括年龄、性别、吸烟史、冠心病家族史、高血压、高胆固醇血症、糖尿病、慢性肾衰竭、脑血管疾病以及急性冠状动脉综合征、经皮腔内血管成形术（PTA）、冠状动脉旁路移植术和心力衰竭史。
5 项指标（糖尿病、慢性肾衰竭、PTA 或旁路移植术、心力衰竭史）与 30 天不良结局相关（31 例/1262 例；2.5%）。入选指标的受试者工作特征曲线下面积为 0.726（95%置信区间，0.654-0.798）；敏感性为 90.3%（73.1-95.8），特异性为 54.8%（52.0-57.6）。类似的一组指标（年龄较大、糖尿病、慢性肾衰竭、PTA 史）预测 6 个月不良结局（90 例[7.1%]，准确性较低（受试者工作特征曲线下面积，0.610[95%置信区间，0.594-0.627，P<.05]；敏感性，98.9%[95%置信区间，93.1-99.6%]；特异性，21.6%[95%置信区间，19.4-23.9%]）。
在病因不明胸痛患者中，所选临床指标无法准确预测不良结局风险。
