Background

Current guidelines emphasize the diagnostic value of non-cardiac or possibly cardiac chest pain. The goal of this analysis was to determine whether German chest pain units (CPUs) adequately address conditions with “atypical” chest pain in existing diagnostic structures.

Method

A total of 11,734 patients from the German CPU registry were included. The analyses included mode of admission, critical time intervals, diagnostic steps, and differential diagnoses.

Results

Patients with unspecified chest pain were younger, more often female, were less likely to have classic cardiovascular risk factors and tended to present more often as self-referrals. Patients with acute coronary syndrome (ACS) mostly had prehospital medical contact. Overall, there was no difference between these two groups regarding the time from the onset of first symptoms to arrival at the CPU. In the CPU, the usual basic diagnostic measures were performed irrespective of ACS as the primary working diagnosis. In the non-ACS group, further ischemia-specific diagnostics were rarely performed. Extra-cardiac differential diagnoses were not specified.

Conclusion

The establishment of broader awareness programs and opening CPUs for low-threshold evaluation of self-referring patients should be discussed. Regarding the rigid focus on the clarification of cardiac causes of chest pain, a stronger interdisciplinary approach should be promoted.

中文翻译：

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心脏性、可能心脏性和可能非心脏性胸痛

背景

目前的指南强调非心源性或可能心源性胸痛的诊断价值。本分析的目的是确定德国胸痛单元 (CPU) 是否能够充分解决现有诊断结构中“非典型”胸痛的情况。

方法

德国 CPU 登记处总共纳入了 11,734 名患者。分析包括入院方式、关键时间间隔、诊断步骤和鉴别诊断。

结果

未明确的胸痛患者较年轻，女性居多，具有典型心血管危险因素的可能性较小，并且往往更多地表现为自我转诊。急性冠状动脉综合征（ACS）患者大多有过院前医疗接触。总体而言，从首次症状出现到到达 CPU 的时间，两组之间没有差异。在 CPU 中，无论 ACS 是否作为主要工作诊断，都会执行通常的基本诊断措施。在非 ACS 组中，很少进行进一步的缺血特异性诊断。未指定心脏外鉴别诊断。

结论

应讨论建立更广泛的意识计划和开放 CPU 以对自我转介患者进行低阈值评估。对于僵化地关注澄清胸痛的心脏原因，应该提倡更强的跨学科方法。