伴随呼吸困难与急性胸痛患者的诊断和结局的关系。

Association of accompanying dyspnoea with diagnosis and outcome of patients presenting with acute chest discomfort.

机构信息

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.

GREAT network, Rome, Italy.

出版信息

Eur Heart J Acute Cardiovasc Care. 2023 May 4;12(5):283-295. doi: 10.1093/ehjacc/zuad026.

DOI:10.1093/ehjacc/zuad026

PMID:36917461

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10243981/

Abstract

AIMS

The presence of accompanying dyspnoea is routinely assessed and common in patients presenting with acute chest pain/discomfort to the emergency department (ED). We aimed to assess the association of accompanying dyspnoea with differential diagnoses, diagnostic work-up, and outcome.

METHODS AND RESULTS

We enrolled patients presenting to the ED with chest pain/discomfort. Final diagnoses were adjudicated by independent cardiologists using all information including cardiac imaging. The primary diagnostic endpoint was the final diagnosis. The secondary diagnostic endpoint was the performance of high-sensitivity cardiac troponin (hs-cTn) and the European Society of Cardiology (ESC) 0/1h-algorithms for the diagnosis of myocardial infarction (MI). The prognostic endpoints were cardiovascular and all-cause mortality at two years. Among 6045 patients, 2892/6045 (48%) had accompanying dyspnoea. The prevalence of acute coronary syndrome (ACS) in patients with vs. without dyspnoea was comparable (MI 22.4% vs. 21.9%, P = 0.60, unstable angina 8.7% vs. 7.9%, P = 0.29). In contrast, patients with dyspnoea more often had cardiac, non-coronary disease (15.3% vs. 10.2%, P < 0.001). Diagnostic accuracy of hs-cTnT/I concentrations was not affected by the presence of dyspnoea (area under the curve 0.89-0.91 in both groups), and the safety of the ESC 0/1h-algorithms was maintained with negative predictive values >99.4%. Accompanying dyspnoea was an independent predictor for cardiovascular and all-cause death at two years [hazard ratio 1.813 (95% confidence intervals, 1.453-2.261, P < 0.01)].

CONCLUSION

Accompanying dyspnoea was not associated with a higher prevalence of ACS but with cardiac, non-coronary disease. While the safety of the diagnostic work-up was not affected, accompanying dyspnoea was an independent predictor for cardiovascular and all-cause death.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587.

摘要

目的

伴随呼吸困难是急诊科（ED）急性胸痛/不适患者的常规评估指标，且较为常见。我们旨在评估伴随呼吸困难与鉴别诊断、诊断检查和预后的关系。

方法和结果

我们纳入了因胸痛/不适而到 ED 就诊的患者。最终诊断由独立的心脏病专家根据包括心脏影像学在内的所有信息进行裁定。主要诊断终点为最终诊断。次要诊断终点为高敏肌钙蛋白（hs-cTn）的检测和欧洲心脏病学会（ESC）0/1h 算法用于诊断心肌梗死（MI）的性能。预后终点为两年时的心血管和全因死亡率。在 6045 例患者中，2892/6045（48%）例患者伴有呼吸困难。有呼吸困难的患者与无呼吸困难的患者急性冠状动脉综合征（ACS）的患病率相当（MI 22.4%比 21.9%，P=0.60，不稳定型心绞痛 8.7%比 7.9%，P=0.29）。相比之下，有呼吸困难的患者更常患有心脏非冠状动脉疾病（15.3%比 10.2%，P<0.001）。hs-cTnT/I 浓度的诊断准确性不受呼吸困难的影响（两组的曲线下面积为 0.89-0.91），ESC 0/1h 算法的安全性得以维持，阴性预测值>99.4%。伴随呼吸困难是两年时心血管和全因死亡的独立预测因素[风险比 1.813（95%置信区间，1.453-2.261，P<0.01）]。