Zarling E J, Sexton H, Milnor P
JAMA. 1983 Sep 2;250(9):1177-81.
A retrospective study of 100 consecutive cases of autopsy-proved acute myocardial infarction has disclosed a surprisingly low frequency (53%) of correct antemortem diagnoses. Incorrect diagnoses seemed to be caused by (1) unjustified dependence on misleading laboratory studies, (2) inattention to suggestive or diagnostic laboratory studies, (3) atypical or obscure presentation of myocardial infarction, and (4) failure to consider acute myocardial infarction as a diagnostic possibility, particularly when the responsible physician was not a specialist in internal medicine or its subspecialty of cardiology. Suggested corrective measures are a more appropriate use of the ECG and the laboratory and education and reeducation of selected groups of physicians.
一项对100例经尸检证实的急性心肌梗死连续病例的回顾性研究发现，生前正确诊断的频率出奇地低（53%）。诊断错误似乎是由以下原因造成的：（1）对具有误导性的实验室检查结果过度依赖；（2）对提示性或诊断性实验室检查结果不够重视；（3）心肌梗死的表现不典型或不明显；（4）没有将急性心肌梗死作为一种诊断可能性来考虑，尤其是当主治医生不是内科或其心脏病学亚专业的专家时。建议的纠正措施是更恰当地使用心电图和实验室检查，并对特定医生群体进行教育和再教育。
