Non-chest pain symptoms and likelihood of coronary occlusion in emergency department patients with ST segment elevation undergoing emergent coronary angiography.
Zhiyuan Ma, Marc Kervin Antoine, Huseng Vefali, Yugandhar Manda, Philip Salen, Melinda Shoemaker, Jill Stoltzfus, Peter Puleo
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Abstract
Objectives: Patients presenting with suspected ST segment elevation myocardial infarction frequently have symptoms in addition to chest pain, including dyspnea, nausea or vomiting, diaphoresis, and lightheadedness or syncope. These symptoms are often regarded as supporting the diagnosis of infarction. We sought to determine the prevalence of the non-chest pain symptoms among patients who were confirmed as having a critically diseased coronary vessel as opposed to those with no angiographic culprit lesion.
Methods: Data from 1393 consecutive patients with ST segment elevation who underwent emergent coronary angiography were analyzed. Records were reviewed in detail for symptoms, ECG findings, prior history, angiographic findings, and in-hospital outcomes.
Results: Dyspnea was present in 50.8% of patients, nausea or vomiting in 36.5%, diaphoresis in 51.2%, and lightheadedness/syncope in 16.8%. On angiography, 1239 (88.9%) patients had a culprit lesion and 154 (11.1%) were found not to have a culprit. Only diaphoresis had a higher prevalence among the patients with, as compared with those without a culprit, with an odds ratio of 2.64 ( P < 0.001). The highest occurrence of diaphoresis was among patients with a totally occluded artery, with an intermediate frequency among patients with a subtotal stenosis, and the lowest prevalence among those with no culprit. These findings were consistent regardless of ECG infarct location, affected vessel, patient age, or sex. Among the subset of patients who presented without chest discomfort, none of the symptoms were associated with the presence of a culprit.
Conclusion: The presence of diaphoresis, but not dyspnea, nausea, or lightheadedness is associated with an increased likelihood that patients presenting with ST elevation will prove to have a culprit lesion. In patients who present with ST elevation but without chest discomfort, these symptoms should not be regarded as 'chest pain equivalents'. Further objective data among patients with angiographic confirmation of culprit lesion status is warranted.
目的：疑似 ST 段抬高型心肌梗死的患者除胸痛外还常伴有其他症状，包括呼吸困难、恶心或呕吐、全身乏力、头晕或晕厥。这些症状通常被视为心肌梗死诊断的佐证。我们试图确定被确诊为冠状动脉血管严重病变的患者与没有血管造影罪魁祸首病变的患者之间非胸痛症状的发生率：方法： 分析了 1393 名连续接受急诊冠状动脉造影术的 ST 段抬高患者的数据。详细审查了患者的症状、心电图结果、既往史、血管造影结果和住院结果等记录：结果：50.8%的患者出现呼吸困难，36.5%的患者出现恶心或呕吐，51.2%的患者出现心悸，16.8%的患者出现头晕/晕厥。在血管造影检查中，1239 名患者（88.9%）有病灶，154 名患者（11.1%）没有病灶。与没有罪魁祸首的患者相比，只有舒张症的发病率较高，其几率比为 2.64（P 结论：舒张症的发病率高于无罪魁祸首的患者）：出现舒张而非呼吸困难、恶心或头晕，与出现 ST 波抬高的患者被证实有罪魁祸首病变的可能性增加有关。对于出现 ST 波抬高但无胸部不适的患者，不应将这些症状视为 "胸痛等同物"。有必要在血管造影证实为罪魁祸首病变的患者中进一步收集客观数据。
期刊介绍：
Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management.
Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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