Ayerbe Luis, González Esteban, Gallo Valentina, Coleman Claire L, Wragg Andrew, Robson John
Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
Family Medicine Unit, Department of Medicine, Autónoma University of Madrid, Madrid, Spain.
BMC Cardiovasc Disord. 2016 Jan 20;16:18. doi: 10.1186/s12872-016-0196-4.
The clinical assessment of patients with chest pain of recent onset remains difficult. This study presents a critical review of clinical predictive tools for the assessment of patients with chest pain.
Systematic review of observational studies and estimation of probabilities of coronary artery disease (CAD) in patients with chest pain. Searches were conducted in PubMed, Embase, Scopus, and Web of Science to identify studies reporting tools, with at least three variables from clinical history, physical examination or ECG, produced with multivariate analysis, to estimate probabilities of CAD in patients with chest pain of recent onset, published from inception of the database to the 31st July 2015. The references of previous relevant reviews were hand searched. The methodological quality was assessed with standard criteria. Since the incidence of CAD has changed in the past few decades, the date of publication was acknowledged to be relevant in order to use the tool in clinical practice, and more recent papers were considered more relevant. Probabilities of CAD according to the studies of highest quality were estimated and the evidence provided was graded.
Twelve papers were included out of the 19126 references initially identified. The methodological quality of all of them was high. The clinical characteristics of the chest pain, age, past medical history of cardiovascular disease, gender, and abnormalities in the ECG were the predictors of CAD most commonly reported across the studies. The most recent papers, with highest methodological quality, and most practical for use in clinical settings, reported prediction or exclusion of CAD with area under the curve 0.90 in Primary Care, 0.91 in Emergency department, and 0.79 in Cardiology. These papers provide evidence of high level (1B) and the recommendation to use their results in the management of patients with chest pain is strong (A).
The risk of CAD can be estimated on clinical grounds in patients with chest pain in different clinical settings with high accuracy. The estimation of probabilities of CAD presented in these studies could be used for a better management of patients with chest pain and also in the development of future predictive tools.
对近期出现胸痛症状的患者进行临床评估仍然具有挑战性。本研究对用于评估胸痛患者的临床预测工具进行了批判性综述。
对观察性研究进行系统综述，并估算胸痛患者患冠状动脉疾病（CAD）的概率。检索了PubMed、Embase、Scopus和Web of Science数据库，以确定报告了通过多变量分析得出的、包含至少三个来自临床病史、体格检查或心电图变量的工具的研究，这些研究用于估算近期出现胸痛症状的患者患CAD的概率，检索时间范围从数据库建立之初至2015年7月31日。对手动检索的先前相关综述的参考文献进行了检索。采用标准标准评估方法学质量。由于过去几十年CAD的发病率发生了变化，为了在临床实践中使用该工具，出版日期被认为具有相关性，并且认为最新的论文更具相关性。根据质量最高的研究估算了CAD的概率，并对所提供的证据进行了分级。
在最初识别的19126篇参考文献中，纳入了12篇论文。所有论文的方法学质量都很高。胸痛的临床特征、年龄、心血管疾病既往史、性别以及心电图异常是各项研究中最常报告的CAD预测因素。最新的论文，方法学质量最高，且在临床环境中最实用，报告了在初级保健中预测或排除CAD的曲线下面积为0.90，在急诊科为0.91，在心脏病学中为0.79。这些论文提供了高级别（1B）的证据，并且强烈推荐（A）在胸痛患者的管理中使用其结果。
在不同临床环境下，基于临床依据可以高精度地估算胸痛患者患CAD的风险。这些研究中呈现的CAD概率估算可用于更好地管理胸痛患者，也可用于未来预测工具的开发。
