Department of Internal Medicine, Duke University Hospital, Durham, NC.
Division of Cardiovascular Medicine, Duke University Hospital, Durham, NC.
Am Heart J. 2020 Apr;222:191-198. doi: 10.1016/j.ahj.2020.02.001. Epub 2020 Feb 5.
Data regarding emergency department (ED) assessment of acute chest pain (CP) and incidence of myocardial infarction (MI) among adult congenital heart disease (ACHD) patients, relative to the non-congenital population, is lacking.
To describe MI risk in ACHD patients presenting to the ED with chest pain and to compare clinical characteristics, diagnostic testing patterns, and outcomes to controls.
We retrospectively identified a cohort of ACHD patients presenting with acute CP and matched them with non-ACHD controls at a large tertiary-level ED during the period 1998-2018.
The congenital and control cohorts comprised 297 patients respectively. While MI was less common among ACHD patients (5.2%) than controls (19.7%), P = .01, arrhythmia (14% vs 6%, P < .001) and acute heart failure (3% vs 0.3%, P = .02) were more often the cause of symptoms. Despite more often presenting with non-anginal CP (81% vs 66%, P < .001) and having fewer CAD risk factors (P = .03), ACHD patients underwent more frequent stress testing (22% vs 14%, P < .001) and underwent invasive coronary angiography with equal frequency (7% vs 8%, P = .99). The trend of greater diagnostic scrutiny for acute coronary disease, in the absence of increased risk, strongly correlated with degree of congenital complexity. Both CP character and HEART Score reliably predicted MI for ACHD patients and controls (both P < .001).
MI is an uncommon cause of CP among ACHD patients presenting to the ED and occurs less frequently than seen in the general population. Established MI predictors, CP character and HEART Score, can reliably identify MI in ACHD patients.
目前缺乏有关成人先天性心脏病（ACHD）患者在急诊科（ED）评估急性胸痛（CP）和心肌梗死（MI）发生率的数据，与非先天性人群相比。
描述因胸痛就诊于 ED 的 ACHD 患者的 MI 风险，并将其与对照组的临床特征、诊断检测模式和结局进行比较。
我们回顾性地确定了一组在 1998 年至 2018 年期间在一家大型三级 ED 就诊的急性 CP 的 ACHD 患者队列，并与非 ACHD 对照组进行了匹配。
先天性组和对照组分别包含 297 例患者。虽然 ACHD 患者的 MI 发生率（5.2%）低于对照组（19.7%），但 P=0.01，心律失常（14%对 6%，P<0.001）和急性心力衰竭（3%对 0.3%，P=0.02）更常为症状的原因。尽管 ACHD 患者更常表现为非心绞痛性 CP（81%对 66%，P<0.001）且 CAD 危险因素更少（P=0.03），但 ACHD 患者更频繁地接受应激试验（22%对 14%，P<0.001），且经皮冠状动脉造影的频率相等（7%对 8%，P=0.99）。在没有增加风险的情况下，对急性冠状动脉疾病进行更大程度的诊断检查的趋势与先天性复杂性的程度强烈相关。CP 特征和 HEART 评分都可靠地预测了 ACHD 患者和对照组的 MI（均 P<0.001）。
MI 是 ACHD 患者就诊于 ED 的 CP 的罕见原因，其发生率低于一般人群。已建立的 MI 预测因素，CP 特征和 HEART 评分，可可靠地识别 ACHD 患者的 MI。
