Davie A P, Caesar D, Caruana L, Clegg G, Spiller J, Capewell S, Starkey I R, Shaw T R, McMurray J J
MRC Clinical Research Initiative in Heart Failure, University of Glasgow, UK.
QJM. 1998 May;91(5):339-43. doi: 10.1093/qjmed/91.5.339.
Chest pain accounts for much of the rising numbers of emergency admissions, but in-patient assessment is not necessarily the best way of dealing with these patients. We ran a 'rapid-assessment chest pain clinic' to provide an alternative route of assessment, and audited its outcome. General practitioners referred patients with recent-onset chest pain, increasing chest pain, chest pain at rest, or other chest pain of concern, on the understanding that they would be seen within 24 h. During 8 1/2 months, 334 patients were referred and 317 patients were seen, most of whom had exercise electrocardiography. A median of 6 months later, 278 patients were personally contacted to determine outcome. Of these, 18% had been admitted immediately with acute coronary syndromes, and 49% had been diagnosed as non-coronary chest pain (none of whom subsequently infarcted or died). Continuing symptoms were infrequent, and satisfaction was high, although 13% of patients had been revascularized. A significant number of patients required immediate admission and/or ultimate revascularization, but many more did not. The majority of these patients had non-coronary chest pain, and this diagnosis was substantiated by their excellent outcome and (in some cases) by further investigation.
胸痛是急诊入院人数不断增加的主要原因之一，但住院评估不一定是处理这些患者的最佳方式。我们开设了一家“胸痛快速评估诊所”，以提供另一种评估途径，并对其结果进行了审核。全科医生转诊近期出现胸痛、胸痛加重、静息性胸痛或其他令人担忧的胸痛患者，并告知他们将在24小时内得到诊治。在8个半月的时间里，共转诊了334例患者，诊治了317例患者，其中大多数患者进行了运动心电图检查。在中位时间6个月后，亲自联系了278例患者以确定结果。其中，18%的患者因急性冠状动脉综合征立即入院，49%的患者被诊断为非冠状动脉性胸痛（这些患者随后均未发生梗死或死亡）。持续症状很少见，患者满意度很高，尽管13%的患者接受了血运重建。相当数量的患者需要立即入院和/或最终进行血运重建，但更多患者不需要。这些患者中的大多数患有非冠状动脉性胸痛，这一诊断通过其良好的预后以及（在某些情况下）进一步检查得到了证实。
