Department of Emergency and Critical Care Medicine, City Hospital Nuremberg, Nuremberg, Germany.
Clin Chem Lab Med. 2011 Sep 6;49(12):1955-63. doi: 10.1515/CCLM.2011.695.
Evaluating patients with acute chest pain presenting to the emergency department remains an ongoing challenge. The spectrum of etiologies in acute chest pain ranges from minor disease entities to life-threatening diseases, such as pulmonary embolism, acute aortic dissection or acute myocardial infarction (MI). The diagnosis of acute MI is usually made integrating the triad of patient history and clinical presentation, readings of 12-lead ECG and measurement of cardiac troponins (cTn). Introduction of high-sensitivity cTn assays substantially increases sensitivity to identify patients with acute MI even at the time of presentation to the emergency department at the cost of specificity. However, the proportion of patients presenting with cTn positive, non-vascular cardiac chest pain triples with the implementation of new sensitive cTn assays increasing the difficulty for the emergency physician to identify those patients who are at need for invasive diagnostics. The main objectives of this mini-review are 1) to discuss elements of disposition decision made by the emergency physician for the evaluation of chest pain patients, 2) to summarize recent advances in assay technology and relate these findings into the clinical context, and 3) to discuss possible consequences for the clinical work and suggest an algorithm for the clinical evaluation of chest pain patients in the emergency department.
评估因急性胸痛而到急诊科就诊的患者仍然是一项持续存在的挑战。急性胸痛的病因范围从轻微的疾病实体到危及生命的疾病，如肺栓塞、急性主动脉夹层或急性心肌梗死 (MI)。急性 MI 的诊断通常通过整合患者病史和临床表现、12 导联心电图读数和心肌肌钙蛋白 (cTn) 的测量来做出。高敏 cTn 检测的引入大大提高了识别急性 MI 患者的敏感性，即使在急诊科就诊时也是如此，但其代价是特异性降低。然而，随着新的敏感 cTn 检测方法的实施，cTn 阳性、非血管性胸痛的患者比例增加了两倍，这增加了急诊医生识别那些需要有创诊断的患者的难度。本篇迷你综述的主要目的是：1）讨论急诊科医生在评估胸痛患者时做出处置决策的要素；2）总结检测技术的最新进展，并将这些发现与临床情况联系起来；3）讨论这些发现对临床工作可能产生的影响，并为急诊科胸痛患者的临床评估提出一个算法。
