EARLY PREDICTION OF ACUTE MYOCARDIAL-INFARCTION FROM CLINICAL HISTORY, EXAMINATION AND ELECTROCARDIOGRAM IN THE EMERGENCY ROOM
EARLY PREDICTION OF ACUTE MYOCARDIAL-INFARCTION FROM CLINICAL HISTORY, EXAMINATION AND ELECTROCARDIOGRAM IN THE EMERGENCY ROOM
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DOI：
10.1016/0002-9149(91)90739-8
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发表时间：
1991-07-15
影响因子：
2.8
通讯作者：
HJALMARSON, A
中科院分区：
文献类型：
--
作者：
KARLSON, BW;HERLITZ, J;HJALMARSON, A
早期预测急性心肌梗死（AMI）的可能性评估了在21个月期间连续来到我们急诊室的7157例胸痛或其他提示AMI症状的患者。在这些患者中，921人在入院头3天内发生急性心肌梗塞。在入院的4,690例患者中，1,576例（34%）的入院心电图正常，其中90例（6%）发展为AMI。在1964例无急性缺血征像的心电图异常患者中（占入院患者的42%），268例（14%）发生AMI， 1109例心电图显示急性缺血的患者中（24%）563例（51%）发生AMI。所有患者在急诊室根据病史、临床检查和心电图，根据AMI的初始怀疑程度，前瞻性地分为4类中的1类。279例确诊为明显AMI的住院患者（占4690例患者的6%）中，245例（88%）实际发展为AMI；1426例强烈怀疑急性心肌梗死者（30%），478例（34%）发展为急性心肌梗死；2519例有AMI模糊怀疑者（54%），192例（8%）发展为AMI；未怀疑AMI的466例（10%）中有6例（1%）发生AMI。因此，只有低比例的初始心电图正常或最初对AMI有模糊怀疑的患者发展为确诊的AMI。
The possibility of early prediction of acute myocardial infarction (AMI) was assessed in 7,157 consecutive patients coming to our emergency room during a 21-month period with chest pain or other symptoms suggestive of AMI. Of these patients 921 developed an AMI during the first 3 days in the hospital. Of the 4,690 patients admitted to hospital, 1,576 (34%) had a normal admission electrocardiogram, and 90 of these (6%) developed AMI. Of 1,964 patients with an abnormal electrocardiogram without signs of acute ischemia (42% of those admitted), 268 (14%) developed AMI, and 563 (51%) of 1,109 patients with acute ischemia on the electrocardiogram (24%) developed AMI. All patients were prospectively classified in the emergency room on the basis of history, clinical examination and electrocardiogram into 1 of 4 categories, according to the initial degree of suspicion of AMI. Of 279 admitted patients judged to have an obvious AMI (6% of the 4,690), 245 (88%) actually developed AMI; of 1,426 with a strong suspicion of AMI (30%), 478 (34%) developed one; of 2,519 with a vague suspicion of AMI (54%), 192 (8%) developed one; and of 466 with no suspicion of AMI (10%), 6 (1%) developed one. Thus, only a low percentage of the patients with a normal initial electrocardiogram or a vague initial suspicion of AMI developed a confirmed AMI.