Grabert Josefin, Heister Ulrich, Mayr Andreas, Fleckenstein Tobias, Kirfel Andrea, Staerk Christian, Wittmann Maria, Velten Markus
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany.
Emergency Medical Service Bonn, 53103 Bonn, Germany.
Rev Cardiovasc Med. 2023 Mar 2;24(3):75. doi: 10.31083/j.rcm2403075. eCollection 2023 Mar.
Acute coronary syndrome (ACS) is a major cause of morbidity and mortality in the western world. Classic angina pectoris (AP) is a common reason to request prehospital emergency medical services (EMS). Nevertheless, data on diagnostic accuracy and common misdiagnoses are scarce. Therefore, the aim of this study is to evaluate the amount and variety of misdiagnoses and assess discriminating features.
For this retrospective cohort study, all patients requiring EMS for suspected ACS in the city of Bonn (Germany) during 2018 were investigated. Prehospital and hospital medical records were reviewed regarding medical history, presenting signs and symptoms, as well as final diagnosis.
Out of 740 analyzed patients with prehospital suspected ACS, 283 (38.2%) were ultimately diagnosed with ACS (ACS group). Common diagnoses in the cohort with non-confirmed ACS (nACS group) consisted of unspecific pain syndromes, arrhythmias, hypertensive crises, and heart failure. ST segment elevation (adjusted odds-ratios [adj. OR] 2.70), male sex (adj. OR 1.71), T wave changes (adj. OR 1.27), angina pectoris (adj. OR 1.15) as well as syncope (adj. OR 0.63) were identified among others as informative predictors in a multivariable analysis using the lasso technique for data-driven variable selection.
Misdiagnosed ACS is as common as 61.8% in this cohort and analyses point to a complex of conditions and symptoms (i.e., male sex, electrocardiographic (ECG) changes, AP) for correct ACS diagnosis while neurological symptoms were observed significantly more often in the nACS group (e.g., Glasgow Coma Scale (GCS) 15, = 0.03). To ensure adequate and timely therapy for a potentially critical disease as ACS a profound prehospital examination and patient history is indispensable.
急性冠状动脉综合征（ACS）是西方世界发病和死亡的主要原因。典型心绞痛（AP）是请求院前紧急医疗服务（EMS）的常见原因。然而，关于诊断准确性和常见误诊的数据却很稀少。因此，本研究的目的是评估误诊的数量和种类，并评估鉴别特征。
对于这项回顾性队列研究，调查了2018年德国波恩市所有因疑似ACS而需要EMS的患者。回顾了院前和医院病历中的病史、症状和体征以及最终诊断。
在740例分析的院前疑似ACS患者中，283例（38.2%）最终被诊断为ACS（ACS组）。未确诊ACS队列（nACS组）的常见诊断包括非特异性疼痛综合征、心律失常、高血压危象和心力衰竭。在使用套索技术进行数据驱动变量选择的多变量分析中，ST段抬高（调整优势比[adj.OR]2.70）、男性（adj.OR 1.71）、T波改变（adj.OR 1.27）、心绞痛（adj.OR 1.15）以及晕厥（adj.OR 0.63）等被确定为信息性预测指标。
在该队列中，误诊的ACS高达61.8%，分析指出正确诊断ACS需要综合多种情况和症状（即男性、心电图（ECG）改变、AP），而nACS组中神经症状的出现频率明显更高（例如格拉斯哥昏迷量表（GCS）<15，P = 0.03）。为确保对像ACS这样潜在的危重病进行充分及时的治疗，深入的院前检查和患者病史至关重要。
