Araújo Carla, Laszczyńska Olga, Viana Marta, Dias Paula, Maciel Maria Júlia, Moreira Ilídio, Azevedo Ana
EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
Cardiology. 2018;139(2):71-82. doi: 10.1159/000484713. Epub 2017 Dec 23.
The aim of this study was to assess the proportion of patients with a first episode of acute coronary syndrome (ACS) reporting preceding chest pain, having previously sought medical care and undergone the performance of exams, and to identify the determinants of seeking medical advice and undergoing electrocardiogram (ECG).
Within a cohort study, 690 patients with a first episode of ACS were evaluated. A questionnaire was applied to assess chest pain within the preceding 6 months of the event and health system resources utilization. Determinants were identified by logistic regression.
Preceding chest pain was reported by 61% of patients, 43% of these sought medical help, of whom less than half underwent ECG, and in 39% pain was attributed to a problem of the heart. Patients with hypertension were more likely to seek medical care (adjusted odds ratio, OR, 2.13, 95% CI 1.29-3.51), and former smokers (OR 0.52, 95% CI 0.28-0.99) and patients of a higher social class (OR 0.16, 95% CI 0.05-0.48) were less likely to seek medical care. The performance of ECG was associated with male sex (OR 2.56, 95% CI 1.11-5.87), health subsystem coverage (OR 3.88, 95% CI 1.11-13.53), and living in the northeastern region (OR 9.07, 95% CI 4.07-20.24), whereas cognitive impairment (OR 0.37, 95% CI 0.15-0.92) and being employed (OR 0.36, 95% CI 0.14-0.97) were inversely associated.
These results suggest there are opportunities to improve the diagnosis of myocardial ischemia before acute coronary events.
本研究旨在评估首次发作急性冠状动脉综合征（ACS）的患者中，报告有先前胸痛症状、曾寻求医疗护理并接受过检查的患者比例，并确定寻求医疗建议和接受心电图（ECG）检查的决定因素。
在一项队列研究中，对690例首次发作ACS的患者进行了评估。应用一份问卷来评估事件发生前6个月内的胸痛情况以及卫生系统资源利用情况。通过逻辑回归确定决定因素。
61%的患者报告有先前胸痛症状，其中43%寻求了医疗帮助，而这些寻求医疗帮助的患者中不到一半接受了心电图检查，且39%的胸痛被归因于心脏问题。高血压患者更有可能寻求医疗护理（调整后的优势比，OR，2.13，95%置信区间1.29 - 3.51），而既往吸烟者（OR 0.52，95%置信区间0.28 - 0.99）和社会阶层较高的患者（OR 0.16，95%置信区间0.05 - 0.48）寻求医疗护理的可能性较小。心电图检查与男性性别（OR 2.56，95%置信区间1.11 - 5.87）、卫生子系统覆盖范围（OR 3.88，95%置信区间1.11 - 13.53）以及居住在东北地区（OR 9.07，95%置信区间4.07 - 20.24）相关，而认知障碍（OR 0.37，95%置信区间0.15 - 0.92）和就业状态（OR 0.36，95%置信区间0.14 - 0.97）与之呈负相关。
这些结果表明，在急性冠状动脉事件发生前，存在改善心肌缺血诊断的机会。
