Launbjerg J, Fruergaard P, Hesse B, Jørgensen F, Elsborg L, Petri A
Medical Department B, Hillerød Hospital, Copenhagen, Denmark.
Cardiology. 1996 Jan-Feb;87(1):60-6. doi: 10.1159/000177061.
The purpose of the study was to describe the prognosis of patients with acute chest pain of different origin, but without myocardial infarction (non-AMI). A total of 204 patients were included. In 56, a definite diagnosis was obtained within 24-48 H of admission. The remaining 148 patients underwent the following examinations: exercise test, myocardial scintigraphy, echocardiography, Holter monitoring, hyperventilation test, oesophago-gastro-duodenoscopy, oesophageal manometry, oesophageal pH monitoring, Bernstein test, physical chest wall examination, bronchial histamine test, chest X-ray and ultrasonic upper abdominal examination. Ischaemic heart disease (IHD) was diagnosed in 64 patients, 81 had gastro-oesophageal disorders, 58 chest wall disorders, 9 pericarditis, 5 pulmonary embolism, 4 pneumonia/pleuritis, 3 pulmonary cancer, 2 dissecting aortic aneurysm, 1 aortic stenosis and 1 herpes zoster. During follow-up of 33 months, 31 of the 64 patients with IHD had a cardiac event (cardiac deaths, non-fatal AMI, bypass surgery or PTCA), whereas only 3 event occurred among the 140 patients without IHD (p < 0.00001). However, the frequency of readmissions and of recurrent episodes of chest pain were similar in the 3 major diagnostic groups (NS). To conclude, the high-risk subset of a non-AMI population can be identified by means of non-invasive cardiac examination. The remainder who have other diagnoses are at low risk. However, the morbidity is high with frequent readmissions and recurrent episodes of chest pain and the need for development of strategies with regard to diagnosis and treatment of these patients are emphasized.
本研究的目的是描述不同病因但无心肌梗死（非急性心肌梗死，non-AMI）的急性胸痛患者的预后情况。共纳入204例患者。其中56例在入院24 - 48小时内明确诊断。其余148例患者接受了以下检查：运动试验、心肌闪烁显像、超声心动图、动态心电图监测、过度通气试验、食管-胃-十二指肠镜检查、食管测压、食管pH监测、伯恩斯坦试验、胸壁体格检查、支气管组胺试验、胸部X线检查及上腹部超声检查。诊断为缺血性心脏病（IHD）的有64例，胃食管疾病81例，胸壁疾病58例，心包炎9例，肺栓塞5例，肺炎/胸膜炎4例，肺癌3例，主动脉夹层动脉瘤2例，主动脉狭窄1例，带状疱疹1例。在33个月的随访中，64例IHD患者中有31例发生心脏事件（心源性死亡、非致死性急性心肌梗死、搭桥手术或经皮冠状动脉腔内血管成形术），而140例非IHD患者中仅发生3例心脏事件（p < 0.00001）。然而，3个主要诊断组的再次入院频率和胸痛复发频率相似（无统计学差异）。总之，通过无创心脏检查可识别非急性心肌梗死人群中的高危亚组。其余诊断为其他疾病的患者风险较低。然而，发病率较高，再次入院和胸痛复发频繁，强调需要制定针对这些患者的诊断和治疗策略。
