如何应对运动试验阴性的患者

How to Deal with the Negative Patients in a Stress Test

目的指南要求需要进行冠状动脉造影的患者首先应但进行危险评估,对于运动试验阴性的患者应如何应对呢?方法入选既往无明确的冠心病,因胸痛就诊而运动试验阴性的患者,常规进行冠状动脉造影检查,入选患者的基本特征、危险因素、症状,了解相关性。结果共有102例患者入选本实验。平均年龄61岁,62.7%为男性,23.5%存在糖尿病,54.9%有高血压。冠状动脉造影结果显示:有31.4%检出存在阻塞型冠心病。男性、吸烟史、糖尿病、高脂血症、高血压在本实验中仍有明显预测意义。结论本研究中,运动试验阴性患者中有近1/3存在明显的冠状动脉狭窄,提示需要更好的危险分层出现指导临床工作,以减少患者的风险又提高导管的阳性检出率。

Objective Guidelines for triaging patients for cardiac catheterization recommend a risk assessment.How to deal with the negative patients in a stress test.MethodsFrom march 2009 through may 2010,at Dalian central hospital,we identified patients without known coronary artery disease that had chest pain with negative result on a stress test was undergoing elective catheterization.The patients＇ demographic characteristics,risk factors,and symptoms were correlated with the presence of obstructive coronary artery disease.ResultsA total of 102 patients were included in the study.The median age was 61 years;62.7% of the patients were men,23.5% had diabetes,and 54.9% had hypertension.At catheterization,31.4% of the patients had obstructive coronary artery disease.Independent predictors of obstructive coronary artery disease included male sex,smoking,presence of diabetes,presence of hypertension,and presence of dyslipidemia.ConclusionsIn this study,slightly less than one third of patients with negative result on a stress test who underwent elective cardiac catheterization had obstructive coronary artery disease.Better strategies for risk stratification are needed to decrease the risk of patients and to increase the diagnostic yield of cardiac catheterization in routine clinical practice.