CLINICAL CHARACTERISTICS AND NATURAL-HISTORY OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION SENT HOME FROM THE EMERGENCY ROOM
CLINICAL CHARACTERISTICS AND NATURAL-HISTORY OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION SENT HOME FROM THE EMERGENCY ROOM
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DOI：
10.1016/0002-9149(87)90217-7
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发表时间：
1987-08-01
影响因子：
2.8
通讯作者：
GOLDMAN, L
中科院分区：
文献类型：
--
作者：
LEE, TH;ROUAN, GW;GOLDMAN, L
在一项对急诊室急性胸痛患者的前瞻性多中心调查中，医生收治了96%的急性心肌梗死（AMI）患者，出院率为4%。在35名AMI患者中，只有11名（31%）因持续症状返回同一家医院。与随机选择的105名从急诊室入院的AMI患者组成的对照组相比，错过AMI的患者明显更年轻，症状不太典型，并且不太可能有既往AMI或心绞痛或心电图证据缺血或不知道是陈旧性梗死。尽管AMI漏诊患者的临床表现不太典型，但在控制年龄和性别后，AMI漏诊但通过我们的随访程序检测到AMI的患者的短期死亡率显著高于入院的AMI患者。根据独立审查者的确定，49%的遗漏AMI可以通过改善心电图阅读技能或通过入院时存在公认的静息缺血性疼痛或缺血性心电图变化（不知道是陈旧性）的患者进行诊断。
In a prospective multicenter investigation of emergency room patients with acute chest pain, physicians admitted 96% of patients with acute myocardial infarction (AMI) and discharged 4%. Of 35 patients who were sent home with AMI, only 11 (31%) returned to the same hospital because of persistent symptoms. Compared with a control group of 105 randomly selected patients with AMI who were admitted from the energency room, patients in whom AMI was missed were significantly younger, had less typical symptoms and were less likely to have had prior AMI or angina or to have electrocardiographic evidence of ischemia or infarction not known to be old. Despite the less typical presentations of patients in whom AMI was missed, after controlling for age and sex, the short-term mortality rate was significantly higher among patients in whom AMI was missed but in whom it was detected through our follow-up procedures than in admitted AMI patients. As determined by independent reviewers, 49% of the missed AMIs could have been diagnosed through improved electrocardiographic reading skills or by admission of patients with recognized ischemic pain at rest or ischemic electrocardiographic changes not known to be old.