Yiadom Maame Yaa A B, Kosowsky Joshua M
Department of Emergency Medicine, Brigham and Women's Hospital, 10 Vining Street, Neville House, Boston, MA, 02115, USA,
Curr Treat Options Cardiovasc Med. 2011 Feb;13(1):57-67. doi: 10.1007/s11936-010-0108-3.
There is abundant evidence to guide the management of chest pain patients with a confirmed or reasonably suspected diagnosis of acute coronary syndrome (ACS). But when it comes to the low-risk chest pain patient in the emergency department, there is limited evidence to support one approach over another. As a result, the evaluation of low-risk chest pain represents a distinct challenge for the emergency physician. Missing a diagnosis of ACS is certainly undesirable. However, the overuse of technology can result in misleading test results in populations with a low incidence of coronary disease. In this article, we dispel several myths surrounding low-risk chest pain and put forward a number of common-sense recommendations. We endorse taking a focused but thorough chest pain history; encourage the use of serial electrocardiogram, particularly for patients with ongoing or changing symptoms; comment on the interpretation of cardiac biomarkers in the era of highly sensitive troponin assays, drawing a distinction between myocardial injury and myocardial infarction; discuss the role of coronary computed tomography angiography as a test for coronary artery disease, rather than for ACS; and caution against the reflexive use of provocative testing in low-risk chest pain patients.
有大量证据可指导确诊或合理怀疑为急性冠状动脉综合征（ACS）的胸痛患者的管理。但对于急诊科低风险胸痛患者，支持一种方法优于另一种方法的证据有限。因此，对低风险胸痛的评估对急诊科医生来说是一项独特的挑战。漏诊ACS肯定是不可取的。然而，技术的过度使用可能会在冠心病发病率较低的人群中导致误导性的检测结果。在本文中，我们破除了一些围绕低风险胸痛的误区，并提出了一些常识性建议。我们支持获取重点但全面的胸痛病史；鼓励使用系列心电图，特别是对于症状持续或变化的患者；评论在高敏肌钙蛋白检测时代心脏生物标志物的解读，区分心肌损伤和心肌梗死；讨论冠状动脉计算机断层扫描血管造影作为冠状动脉疾病检测而非ACS检测的作用；并告诫不要在低风险胸痛患者中 reflexive 使用激发试验。 （注：这里“reflexive”可能有误，结合语境推测可能是“盲目”之类的意思，但按要求未修改原文词汇）
