Aims

Early heart attack awareness programs are thought to increase efficacy of chest pain units (CPU) by providing live-saving information to the community. We hypothesized that self-referral might be a feasible alternative to activation of emergency medical services (EMS) in selected chest pain patients with a specific low-risk profile.

Methods and results

In this observational registry-based study, data from 4743 CPU patients were analyzed for differences between those with or without severe or fatal prehospital or in-unit events (out-of-hospital cardiac arrest and/or in-unit death, resuscitation or ventricular tachycardia). In order to identify a low-risk subset in which early self-referral might be recommended to reduce prehospital critical time intervals, the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality and a specific low-risk CPU score developed from the data by multivariate regression analysis were applied and corresponding event rates were calculated. Male gender, cardiac symptoms other than chest pain, first onset of symptoms and a history of myocardial infarction, heart failure or cardioverter defibrillator implantation increased propensity for critical events. Event rates within the low-risk subsets varied from 0.5–2.8%. Those patients with preinfarction angina experienced fewer events.

Conclusions

When educating patients and the general population about angina pectoris symptoms and early admission, activation of EMS remains recommended. Even in patients without any CPU-specific risk factor, self-referral bears the risk of severe or fatal pre- or in-unit events of 0.6%. However, admission should not be delayed, and self-referral might be feasible in patients with previous symptoms of preinfarction angina.

中文翻译：

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即使在低风险胸痛病房患者中也发生了意外的高水平严重事件

目标

早期心脏病发作意识计划被认为可以通过向社区提供挽救生命的信息来提高胸痛单元 (CPU) 的功效。我们假设在特定的低风险胸痛患者中，自我转诊可能是激活紧急医疗服务 (EMS) 的可行替代方案。

方法和结果

在这项基于观察性注册的研究中，分析了来自 4743 名 CPU 患者的数据，以了解有或没有严重或致命的院前或单位内事件（院外心脏骤停和/或单位内死亡、复苏或心室事件）之间的差异心动过速）。为了确定可能建议早期自我转诊以减少院前关键时间间隔的低风险子集，制定了用于院内死亡率的急性冠状动脉事件全球登记 (GRACE) 评分和特定的低风险 CPU 评分应用多元回归分析的数据并计算相应的事件发生率。男性、除胸痛外的心脏症状、首次出现症状和心肌梗塞病史，心力衰竭或心脏复律除颤器植入增加了发生严重事件的倾向。低风险子集中的事件发生率从 0.5% 到 2.8% 不等。那些患有梗死前心绞痛的患者经历的事件较少。

结论

在对患者和一般人群进行有关心绞痛症状和早期入院的教育时，仍然建议激活 EMS。即使在没有任何 CPU 特定风险因素的患者中，自我转诊也承担 0.6% 的严重或致命的单位前或单位内事件的风险。然而，不应延迟入院，对于既往有梗死前心绞痛症状的患者自行转诊可能是可行的。