Berliner Dominik, Maier Lars S, Wollenberg Ulrike, Limberg Roger, Schmitto Jan D, Westermann Dirk, Bauersachs Johann
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Department of Cardiology, Pneumology, and Intensive Care, University Hospital Regensburg, Regensburg, Germany.
J Thorac Dis. 2018 Jun;10(Suppl 15):S1777-S1784. doi: 10.21037/jtd.2017.10.123.
Chronic ischemic heart disease is frequent and represents the most common cause of death in western countries. Angina pectoris, the clinical symptom of myocardial ischemia, is associated with increased morbidity and mortality also in patients without obstructive coronary artery disease. The aim of this study was to investigate the current care of patients with recurrent myocardial ischemia after ruling out significant coronary stenosis in the setting of outpatient care.
Data were obtained by a detailed and structured survey. German cardiologists in outpatient care were interviewed about the management and treatment of outpatients with recurrent angina pectoris after ruling out significant stenoses by coronary angiography. Items were analysed using rating scales [1-10] by means of descriptive methods. Absolute and relative frequency distribution was calculated for the characterisation of qualitative data and multiple-choice questions.
The interviews of 731 cardiologic experts could be included in this analysis. The main results showed that history taking seems to be one major problem in those patients-more than 10% of the expert cardiologists admit that they do not perform a detailed history taking of patients with recurrent angina pectoris. While a classification of the symptoms by means of the CCS classification is rated as important such a classification is not used on a regular basis. Extra-cardiac causes are frequently not excluded before performing coronary angiography (>10% of the cases). A significant fraction (20%) of German cardiologists does not consider the initiation of a specific, antianginal medical treatment as their objective.
The trial revealed deficiencies in the history taking, the proper classification of the symptoms, and the initiation of an adequate drug therapy in patients with recurrent angina pectoris after exclusion of significant coronary stenoses.
慢性缺血性心脏病很常见，是西方国家最常见的死亡原因。心绞痛作为心肌缺血的临床症状，在无阻塞性冠状动脉疾病的患者中也与发病率和死亡率增加相关。本研究的目的是调查在门诊环境中排除明显冠状动脉狭窄后复发性心肌缺血患者的当前护理情况。
通过详细的结构化调查获取数据。对德国门诊心脏病专家进行访谈，了解冠状动脉造影排除明显狭窄后复发性心绞痛门诊患者的管理和治疗情况。使用评分量表[1 - 10]通过描述性方法对项目进行分析。计算绝对和相对频率分布以描述定性数据和多项选择题。
731名心脏病专家的访谈可纳入本分析。主要结果表明，病史采集似乎是这些患者的一个主要问题——超过10%的心脏病专家承认他们没有对复发性心绞痛患者进行详细的病史采集。虽然通过CCS分类对症状进行分类被认为很重要，但这种分类并未经常使用。在进行冠状动脉造影之前，经常不排除心外原因（>10%的病例）。相当一部分（20%）德国心脏病专家不将启动特定的抗心绞痛药物治疗作为目标。
该试验揭示了在排除明显冠状动脉狭窄后复发性心绞痛患者的病史采集、症状的正确分类以及适当药物治疗的启动方面存在不足。
