【争议】急诊科不必要的负荷试验导致过度诊断

《美国医学会杂志-内科学》（JAMA Internal Medicine）1月26日在线发表的一项回顾性分析结果显示，对到急诊科就诊的尚无心肌梗死（MI）的胸痛患者进行非侵入性检查可导致过度诊断和不必要的干预([doi:10.1001/jamainternmed.2014.7657])。

随访6个月后，在421,774例因胸痛到急诊科就诊的患者中，有0.33%例因MI住院。进行运动和负荷心电图试验、心肌灌注显像（MPS）或冠状动脉CT血管成像的患者的MI发生率与未进行这些侵入性检查的患者无差异。

然而，在急诊科进行检查的患者中，干预的应用增加，但MI风险并未同时降低。研究者根据分析数据估计，与未进行检查的患者相比，每27例进行MPS的患者中就有1例进行不必要的插管。推广到约6百万例因主诉胸痛到急诊科就诊的患者中，与未进行检查的患者相比，每100,000例进行MPS的患者中就有约3,700例将进行不必要的插管。

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Noninvasive testing in the emergency department of patients who have chest pain and have not had a myocardial infarction can result in overdiagnosis and unnecessary interventions, based on the results of a retrospective analysis.

After 6 months of follow-up, 0.33% of 421,774 privately insured patients who presented to the emergency department (ED) with chest pain were hospitalized with an MI. There was no difference in the rate of MIs in patients who did and did not undergo exercise and stress electrocardiography, myocardial perfusion scintigraphy (MPS), or coronary CT angiography, Dr. Andrew. J. Foy of Penn State Milton S. Hershey Medical Center in Hershey, Pa., and his colleagues reported in an article published online in JAMA Internal Medicine (2015 Jan. 26 [doi:10.1001/jamainternmed.2014.7657]).

However, interventions were increased in patients who underwent tests without a concomitant reduction in MI in patients who underwent tests in the ED. “Overdiagnosis is a legitimate concern in this patient population,” the study authors wrote. 

Using data from the analysis, the researchers estimated that an unnecessary catheterization is performed in 1 of every 27 patients who undergo MPS instead of an initial strategy of no testing.“When viewed in the broader context of the approximately 6 million ED visits for a chief symptom of chest pain, for every 100,000 patients who undergo MPS instead of an initial strategy of no testing, approximately 3,700 patients will undergo an unnecessary catheterization,” they wrote.

Copyright © 2015 Frontline Medical News, a Frontline Medical Communications, Inc. company. All rights reserved. This material may not be published, broadcast, copied or otherwise reproduced or distributed without the prior written permission of Frontline Medical Communications, Inc.

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