Madsen J K, Thomsen B L, Sorensen J N, Kjeldgaard K M, Kromann-Andersen B
Am J Cardiol. 1987 May 1;59(12):1064-70. doi: 10.1016/0002-9149(87)90849-6.
The prognosis regarding cardiac events--acute myocardial infarction (AMI) or cardiac death after discharge--was evaluated in 257 patients admitted because of suspected AMI due to chest pain, but in whom AMI was not confirmed (non-AMI patients). The findings and patient prognoses were compared with those of 275 patients with confirmed AMI. All patients were younger than 76 years and free of severe chronic diseases, and no cause of chest pain other than possible ischemic heart disease was found. The patients were followed for cardiac events for 11 to 24 months (median 14). The prognoses for the non-AMI patients were significantly better than those for the AMI patients (p = 0.05). The proportion without a cardiac event after 1 year was estimated at 91% and 86%, respectively. In the non-AMI patients, angina pectoris, previous AMI and electrocardiographic changes on admission (intraventricular block and permanent or transient ST-T changes) were significant predictors of cardiac events by univariate and multivariate analysis. In the AMI patients, female gender, heart failure, previous AMI and angina pectoris were significant predictors of cardiac events by univariate analysis. With use of multivariate analysis, female gender, heart failure and angina pectoris were independent predictors of cardiac events. Thus, non-AMI patients admitted with chest pain have a high risk of cardiac events after discharge. The risk is highest when there is evidence of coronary artery disease (electrocardiographic changes on admission and angina pectoris or previous AMI.
对257例因胸痛疑似急性心肌梗死（AMI）入院但未确诊AMI的患者（非AMI患者）进行了出院后心脏事件（急性心肌梗死或心源性死亡）的预后评估。将这些患者的研究结果和预后与275例确诊AMI的患者进行了比较。所有患者年龄均小于76岁，且无严重慢性病，除可能的缺血性心脏病外未发现其他胸痛原因。对患者进行了11至24个月（中位数14个月）的心脏事件随访。非AMI患者的预后明显好于AMI患者（p = 0.05）。估计1年后无心脏事件的比例分别为91%和86%。在非AMI患者中，通过单因素和多因素分析，心绞痛、既往AMI以及入院时的心电图改变（室内传导阻滞和永久性或暂时性ST-T改变）是心脏事件的显著预测因素。在AMI患者中，通过单因素分析，女性、心力衰竭、既往AMI和心绞痛是心脏事件的显著预测因素。采用多因素分析时，女性、心力衰竭和心绞痛是心脏事件的独立预测因素。因此，因胸痛入院的非AMI患者出院后发生心脏事件的风险较高。当有冠状动脉疾病证据（入院时心电图改变、心绞痛或既往AMI）时，风险最高。
