Ladwig K H, Hoberg E, Busch R
Institut u. Poliklinik für Psychosomatische Medizin, Psychotherapie und Med. Psychologie der TU München.
Psychother Psychosom Med Psychol. 1998 Feb;48(2):46-54.
About 1/3 of patients with chest pain undergoing coronary arteriography (CA) have no coronary artery disease (CAD). Individuals with non-CAD chest pain may be younger and more likely to be female; they may express higher degrees of neuroticism. Are those features stable enough to justifi; exclusion from CA if present? To investigate this issue, data on psychodiagnostic parameters (depression, anxiety, somatic complaints) were obtained in patients before this were referred to CA. Inclusion criteria were a chief complaint of chest pain with episodes of angina-like pain at rest, suspicious enough to warrant cardiac catherisation; and no prior history of CAD or other organic heart disease. The sample consisted of 77 patients, recruited from 89 eligible patients. 12 patients were excluded because CA findings were missing for multiple reasons. CA was conducted by Judkins technique. Patients were labeled as CAD (-) if no stenosis were detectable. In 50 (65%) of cases CA findings were positive and in 27 (35%) findings were negative. CAD+ were significantly older (p < 0.05); the superiority in both groups were male. Prevalence of emotional disorders was markedly more pronounced in both groups in comparison to the normal population and to a group of male myocardial infarction survivors. However, those features did not discriminate between the groups. Long acting chest pain was predictive for high degrees of emotional disability (relative risk 5.33; 95% Kl 1.6-61.6; p < 0.012). Chest pain at rest is a major source of anxiety, depression and subsequent somatic preoccupation despite its ischaemic or functional origin. It leads to clinically relevant adjustment disorders in a significant proportion of chest pain patients and triggers emotional disstress. These factors may thus have less impact on risk stratification than expected.
接受冠状动脉造影（CA）的胸痛患者中约有1/3没有冠状动脉疾病（CAD）。非CAD胸痛患者可能更年轻，女性比例更高；他们可能表现出更高程度的神经质。这些特征是否足够稳定，以至于如果存在就足以证明可以不进行CA检查？为了研究这个问题，在患者被转诊进行CA检查之前，获取了心理诊断参数（抑郁、焦虑、躯体不适）的数据。纳入标准为以胸痛为主诉，伴有静息时类似心绞痛的疼痛发作，可疑程度足以进行心脏导管检查；且既往无CAD或其他器质性心脏病史。样本包括从89名符合条件的患者中招募的77名患者。12名患者因多种原因缺少CA检查结果而被排除。CA采用Judkins技术进行。如果未检测到狭窄，则将患者标记为CAD（-）。在50例（65%）病例中，CA检查结果为阳性，27例（35%）结果为阴性。CAD阳性患者年龄显著更大（p<0.05）；两组中男性占优势。与正常人群和一组男性心肌梗死幸存者相比，两组中情绪障碍的患病率明显更高。然而，这些特征并不能区分两组。长期胸痛可预测高度的情绪残疾（相对风险5.33；95%可信区间1.6 - 61.6；p<0.012）。尽管胸痛的起源是缺血性或功能性的，但静息时的胸痛仍是焦虑、抑郁及随后躯体关注的主要来源。它在相当一部分胸痛患者中导致临床上相关的适应障碍，并引发情绪困扰。因此，这些因素对风险分层的影响可能比预期的要小。
