Karlson B W, Sjöland H, Währborg P, Lindqvist J, Herlitz J
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Eur J Emerg Med. 1997 Jun;4(2):72-80. doi: 10.1097/00063110-199706000-00004.
The aim of this research was to describe men and women who were discharged from the emergency department after having an initial suspicion of acute myocardial infarction ruled out in terms of patient characteristics, symptom reevaluation, electrocardiogram and exercise stress test. Consecutive patients below the age of 65 years who came to the emergency department of Sahlgrenska Hospital with acute chest pain or other symptoms raising suspicion of acute myocardial infarction for whom the suspicion was ruled out either directly in the emergency department or less than 1 day after hospital admission were included in the study. Four hundred and eighty-four patients participated, of whom 295 (61%) were men. Men had a higher prevalence of ischaemic heart disease. The cause of pain was judged similarly at reevaluation compared with in the emergency department in 53% of the cases. Only in 4.6% of the cases were the symptoms judged to be caused by myocardial ischaemia on both occasions. At the initial visit 36.0% of the patients were judged to have uncertain cause of the symptoms. This proportion was lowered to 26.4% at reevaluation. The exercise electrocardiogram at reevaluation revealed clinical and electrocardiographic signs indicating definite myocardial ischaemia in 2.6% of the cases. Early follow-up of patients discharged from the emergency department after acute myocardial infarction was ruled out revealed that a low proportion showed signs of myocardial ischaemia. In about half of the cases the judgement differed from that being made in the emergency department.
本研究旨在根据患者特征、症状重新评估、心电图及运动负荷试验，描述那些最初疑似急性心肌梗死但在急诊科被排除的男性和女性患者。连续纳入年龄在65岁以下、因急性胸痛或其他引起急性心肌梗死怀疑症状前来萨尔格伦斯卡医院急诊科就诊，且在急诊科直接排除或入院后不到1天被排除急性心肌梗死怀疑的患者。共有484例患者参与研究，其中295例（61%）为男性。男性缺血性心脏病患病率较高。53%的病例在重新评估时对疼痛原因的判断与在急诊科时相似。仅4.6%的病例在两次评估时均判定症状由心肌缺血引起。初诊时36.0%的患者被判定症状原因不明。重新评估时这一比例降至26.4%。重新评估时的运动心电图显示2.6%的病例有临床和心电图征象提示明确的心肌缺血。对急性心肌梗死被排除后从急诊科出院的患者进行早期随访发现，出现心肌缺血征象的比例较低。约半数病例的判断与急诊科的判断不同。
