Wilson S J, Bloomfield P, Collinson P O
Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
J R Coll Physicians Edinb. 2012;42(3):229-35. doi: 10.4997/JRCPE.2012.310.
The management of coronary disease has moved forward with the application of more sensitive blood biomarkers for early detection alongside more structured symptom assessment, examination and serial ECG measures. However every episode of exertional chest pain isn't symptomatic coronary disease and given massive public awareness campaigns we now face a different management issue with undiagnosed chest pain sent as a 'rule-out' activity. These urgent referrals are often justified based on the management of the minority with unstable coronary disease without preliminary medical review or examination. Avoiding delay which is valuable in coronary patients may be irrelevant to the majority. The overall effectiveness of this pathway is unclear where the patient does not have coronary disease but also where superficial interpretation can be misleading through non-specificity. Do biomarker assays become the answer to every chest pain patient and has the basic assessment of the individual patient and a prior probability of disease no role to play? Does this activity represent a burden or an irrelevant dead end for non-coronary patients? We have asked for comment from two leading authorities on the evolving role and application of cardiac biomarker technologies in managing this considerable and common clinical dilemma.
随着更敏感的血液生物标志物用于早期检测，以及更结构化的症状评估、检查和系列心电图测量方法的应用，冠心病的管理取得了进展。然而，并非每一次劳力性胸痛都是症状性冠心病，鉴于大规模的公众宣传活动，我们现在面临着一个不同的管理问题，即未确诊的胸痛被作为“排除”活动转诊。这些紧急转诊往往基于对少数不稳定型冠心病患者的管理，而没有进行初步的医学评估或检查。避免对冠心病患者至关重要的延误，对大多数患者可能并不相关。当患者没有冠心病时，以及当表面解读可能因非特异性而产生误导时，这条途径的总体有效性尚不清楚。生物标志物检测是否能解决每一位胸痛患者的问题，对个体患者的基本评估和疾病的先验概率是否毫无作用？对于非冠心病患者，这种活动是一种负担还是一个无关紧要的死胡同？我们已征求了两位权威人士对心脏生物标志物技术在解决这一重大且常见临床困境中不断演变的作用和应用的意见。
