Solomon Robert, Nowak Richard, Hudson Michael, Moyer Michele, Jacobsen Gordon, McCord James
Curr Probl Cardiol. 2021 Mar;46(3):100555. doi: 10.1016/j.cpcardiol.2020.100555. Epub 2020 Mar 5.
Patient interviews regarding the duration of symptoms are commonly conducted when evaluating a patient with possible acute myocardial infarction (AMI) and are believed to distinguish between AMI and non-AMI symptoms. In a single center, 569 patients evaluated in the emergency department (ED) for possible AMI from May 2013 to April 2015 were prospectively studied. Patients in the ED were asked by trained research personnel about the duration of their predominant symptom. The final diagnosis of AMI was determined by an independent cardiologist and emergency medicine physician in accordance with the third universal definition of AMI. Disagreements were settled by a third physician (cardiologist) who reviewed the case. There were 44 (8%) AMIs and 484 (85%) patients had chest pain as their predominant symptom. In the 26 type 1 AMIs, the median symptom duration was 3.3 hours, while in the 18 type 2 AMIs it was 1.3 hours. AMI was not present if symptom duration was under 20 minutes and was more likely during the 20-59 minute period. In conclusion, clinical symptoms still play a prominent role in the evaluation of a patient with possible AMI in the ED. Duration of symptoms was not very helpful in distinguishing between patients with AMI and those with non-AMI, except in the time interval of 20-59 minutes.
在评估疑似急性心肌梗死（AMI）的患者时，通常会就症状持续时间对患者进行访谈，人们认为这有助于区分AMI症状和非AMI症状。在一个单一中心，对2013年5月至2015年4月期间在急诊科（ED）评估疑似AMI的569例患者进行了前瞻性研究。急诊科的患者由经过培训的研究人员询问其主要症状的持续时间。AMI的最终诊断由一名独立的心脏病专家和急诊医学医生根据AMI的第三个通用定义确定。如有分歧，则由第三位医生（心脏病专家）复查病例来解决。有44例（8%）为AMI，484例（85%）患者以胸痛为主要症状。在26例1型AMI中，症状持续时间的中位数为3.3小时，而在18例2型AMI中为1.3小时。如果症状持续时间在20分钟以内则不存在AMI，而在20 - 59分钟期间发生AMI的可能性更大。总之，临床症状在急诊科对疑似AMI患者的评估中仍起着重要作用。除了在20 - 59分钟的时间间隔内，症状持续时间对区分AMI患者和非AMI患者帮助不大。
