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.
Herz. 2022 Aug;47(4):374-379. doi: 10.1007/s00059-021-05064-9. Epub 2021 Aug 31.
Early heart attack awareness programs are thought to increase efficacy of chest pain units (CPU) by providing live-saving information to the community. We hypothesized that self-referral might be a feasible alternative to activation of emergency medical services (EMS) in selected chest pain patients with a specific low-risk profile.
In this observational registry-based study, data from 4743 CPU patients were analyzed for differences between those with or without severe or fatal prehospital or in-unit events (out-of-hospital cardiac arrest and/or in-unit death, resuscitation or ventricular tachycardia). In order to identify a low-risk subset in which early self-referral might be recommended to reduce prehospital critical time intervals, the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality and a specific low-risk CPU score developed from the data by multivariate regression analysis were applied and corresponding event rates were calculated. Male gender, cardiac symptoms other than chest pain, first onset of symptoms and a history of myocardial infarction, heart failure or cardioverter defibrillator implantation increased propensity for critical events. Event rates within the low-risk subsets varied from 0.5-2.8%. Those patients with preinfarction angina experienced fewer events.
When educating patients and the general population about angina pectoris symptoms and early admission, activation of EMS remains recommended. Even in patients without any CPU-specific risk factor, self-referral bears the risk of severe or fatal pre- or in-unit events of 0.6%. However, admission should not be delayed, and self-referral might be feasible in patients with previous symptoms of preinfarction angina.
早期心脏病发作意识计划被认为通过向社区提供救生信息来提高胸痛单位（CPU）的疗效。我们假设，对于具有特定低风险特征的选定胸痛患者，自我转诊可能是一种可行的替代方案，而不是激活紧急医疗服务（EMS）。
在这项基于观察性注册的研究中，分析了 4743 名 CPU 患者的数据，以比较有或没有严重或致命的院前或单位内事件（院外心脏骤停和/或单位内死亡、复苏或室性心动过速）的患者之间的差异。为了确定一个低风险亚组，其中可以推荐早期自我转诊以减少院前关键时间间隔，应用了全球急性冠状动脉事件登记（GRACE）评分的院内死亡率和通过多元回归分析从数据中开发的特定低风险 CPU 评分，并计算了相应的事件发生率。男性、胸痛以外的心脏症状、症状首次发作和心肌梗死、心力衰竭或心脏除颤器植入史增加了发生危急事件的倾向。低风险亚组内的事件发生率从 0.5%到 2.8%不等。那些有前驱性心绞痛的患者发生的事件较少。
在教育患者和一般人群关于心绞痛症状和早期入院时，仍然建议激活 EMS。即使在没有任何 CPU 特定危险因素的患者中，自我转诊也有发生严重或致命的院前或单位内事件的风险为 0.6%。然而，不应延迟入院，并且对于有前驱性心绞痛症状的患者，自我转诊可能是可行的。
