Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
Institute for Myocardial Infarction Research Foundation, Ludwigshafen, Germany.
Cardiology. 2021;146(3):304-310. doi: 10.1159/000513695. Epub 2021 Mar 10.
Since 2008, specialized chest pain units (CPUs) were implemented across Germany ensuring structured diagnostics in acute chest pain. This study aims to analyze the management of pulmonary embolism (PE) patients in such certified CPUs.
Data were retrieved from 13,902 patients enrolled in the German CPU registry and analyzed for the diagnosis of PE including patient characteristics, critical time intervals, diagnostic workup, treatment, and prognosis. PE patients were compared to the overall CPU patient cohort. Only patients with a complete 3-month follow-up were included.
Overall, 1.1% of all CPU patients were diagnosed with PE. Chest pain and dyspnea were the leading symptoms. Patients with PE were older, presented with higher heart rates, and more frequently exhibited signs of heart failure, despite a normal left ventricular function. PE patients showed significantly longer time delays between symptom onset and the first medical contact, while PE patients with chest pain presented earlier than PE patients with dyspnea only. Whereas more PE patients had to be transferred to the intensive care unit, in-CPU mortality and event rates over 3 months were low.
DISCUSSION/CONCLUSION: This study suggests a certain risk for underdiagnosis and consecutive potential undertreatment of PE patients in German Cardiac Society (GCS)-certified CPUs, which is thought to result from an anticipated focus on patients with acute coronary syndrome (ACS). Public awareness for PE beyond chest pain should be improved. Certified CPUs should be urged to implement strategic pathways for a better simultaneous diagnostic workup of differential diagnosis beyond ACS.
自 2008 年以来，德国各地都设立了专门的胸痛单元（CPU），以确保急性胸痛的结构化诊断。本研究旨在分析此类经认证的 CPU 中肺栓塞（PE）患者的管理情况。
从德国 CPU 注册中心纳入的 13902 名患者中提取数据，并对 PE 的诊断进行分析，包括患者特征、关键时间间隔、诊断检查、治疗和预后。将 PE 患者与总体 CPU 患者队列进行比较。仅纳入具有完整 3 个月随访的患者。
总体而言，所有 CPU 患者中有 1.1%被诊断为 PE。胸痛和呼吸困难是主要症状。PE 患者年龄较大，心率较高，心力衰竭的体征更常见，尽管左心室功能正常。PE 患者从症状发作到首次医疗接触的时间明显延长，而仅出现胸痛的 PE 患者比仅出现呼吸困难的 PE 患者更早出现症状。尽管更多的 PE 患者需要转至重症监护病房，但 ICU 内死亡率和 3 个月内的事件发生率较低。
讨论/结论：本研究表明，在德国心脏病学会（GCS）认证的 CPU 中，PE 患者存在一定的漏诊和潜在治疗不足的风险，这被认为是由于对急性冠状动脉综合征（ACS）患者的预期关注所致。应提高对 PE 超出胸痛的公众认识。应敦促认证的 CPU 实施战略途径，以便更好地同时对 ACS 以外的鉴别诊断进行诊断检查。
