Department of Psychosomatics and Psychotherapy, University Hospital Cologne, Cologne, Germany; Department of Radiology and Nuclear Medicine, Schleswig-Holstein University Hospital (UK-SH), Campus Lübeck, Lübeck, Germany; Internal Medicine/Cardiology, German Society of Cardiology (DGK), DGK Capital Office, Berlin, Germany; Philipps University Marburg, Department of General Medicine, Preventive and Rehabilitative Medicine, Marburg, Germany; Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany; Cardiology Practice, Munich, Germany.
Dtsch Arztebl Int. 2017 Oct 20;114(42):712-719. doi: 10.3238/arztebl.2017.0712.
Chronic coronary heart disease (CHD) and acute myocardial infarction are endemic conditions. In Germany, an estimated 900 000 cardiac catheterizations were performed in the year 2014, and a percutaneous intervention was carried out in 40% of these procedures. It would be desirable to lessen the number of invasive diagnostic procedures while preserving the reliability of diagnosis. In this article, we present the updated recommendations of the German National Care Guideline for Chronic CHD with regard to diagnostic evaluation.
Updated recommendations for the diagnostic evaluation of chronic CHD were developed on the basis of existing guidelines and a systematic literature review and approved by a formal consensus process.
8-11% of patients with chest pain who present to a general practitioner and 20-25% of those who present to a cardiologist have chronic CHD. General practitioners should estimate the probability of CHD with the Marburg Heart Score. Specialists can use detailed tables for determining the pre-test probability of CHD; if this lies in the range of 15% to 85%, then non-invasive tests should be primarily used for evaluation and treatment planning. If the pretest probability is less than 15%, other potential causes should be ruled out first. If it is over 85%, the presence of CHD should be presumed and treatment planning should be initiated. Coronary angiography is needed only if therapeutic implications are expected (revascularization). Psychosocial risk factors for the development and course of CHD and the patient's quality of life should be regularly assessed as well.
Non-invasive testing and invasive coronary angiography should be used only if their findings are expected to have therapeutic implications. Psychosocial risk factors, the quality of life, and adherence to treatment are important components of these patients' diagnostic evaluation and long-term care.
慢性冠心病（CHD）和急性心肌梗死是常见疾病。在德国，2014 年估计有 90 万例心脏导管检查，其中 40%的病例进行了经皮介入治疗。在保留诊断可靠性的同时，减少侵入性诊断程序的数量是理想的。本文介绍了德国国家慢性 CHD 护理指南中关于诊断评估的最新建议。
在现有指南和系统文献回顾的基础上，制定了慢性 CHD 诊断评估的更新建议，并通过正式共识程序进行了批准。
在全科医生就诊的胸痛患者中，有 8-11%和在心脏病专家就诊的患者中，有 20-25%患有慢性 CHD。全科医生应该使用马尔堡心脏评分来估计 CHD 的可能性。专家可以使用详细的表格来确定 CHD 的术前概率；如果在 15%到 85%之间，则应主要使用非侵入性检查进行评估和治疗计划。如果术前概率小于 15%，则应首先排除其他潜在原因。如果超过 85%，则应假定存在 CHD，并启动治疗计划。只有当有治疗意义（血运重建）时才需要进行冠状动脉造影。还应定期评估 CHD 的发展和病程的社会心理危险因素以及患者的生活质量。
只有当预期发现对治疗有意义时，才应使用非侵入性检查和有创冠状动脉造影。社会心理危险因素、生活质量和治疗依从性是这些患者诊断评估和长期护理的重要组成部分。
