Simple Tool Helps Rule Out Coronary Artery Disease in Primary Care Patients with Chest Pain

五個問題：

女性>65歲，男性>55歲
有已知的血管病史
運動時變厲害
外部觸診時不會有疼痛
病人認為疼痛來源是心臟

兩分及兩分以下可以排除CAD

A prediction tool comprising just five variables can help rule out coronary artery disease (CAD) in primary care patients with chest pain, according to a study in the Canadian Medical Association Journal.


Using a cohort of some 1200 adults presenting to primary care with chest pain, German researchers developed a CAD prediction tool based on five risk factors:


Age of at least 65 for women and 55 for men
Known clinical vascular disease
Worsening pain during exercise
Pain not reproducible on palpation
Patient's assumption that pain is cardiac in nature

The researchers then tested the tool's utility in some 700 additional patients. They found that a score of 2 or lower (i.e., 2 or fewer risk factors) ruled out CAD with a sensitivity of 87%, specificity of 81%, and negative predictive value of 98%.


The authors say they believe their tool "will help to prevent overdiagnosis and needless investigations."


CMAJ article (Free PDF)

CMAJ editorial (Subscription required)

https://docs.google.com/fileview?id=0B278nGJMQBk7NDdiMDllYWYtNGRmZC00MDliLWFhZGYtODdlOTIzMzdjYjlh&hl=zh_TW

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