Οι παράγοντες κινδύνου στεφανιαίας νόσου ΔΕΝ πρέπει να χρησιμοποιούνται στο ΤΕΠ

[πρώτη & καλύτερη]

Σύμφωνα με το παρακάτω σχόλιο από το medscape, οι γνωστοί από τη μελέτη Framingham παράγοντες κινδύνου για στεφανιαία νόσο ΔΕΝ πρέπει να χρησιμοποιούνται κατά την εκτίμηση ασθενούς για οξύ στεφανιαίο σύνδρομο-έμφραγμα του μυοκαρδίου.



Τraditional cardiac risk factors, such as diabetes, are often used in the evaluation of chest pain in the emergency setting to assess the risk for potential myocardial infarction (MI). Body and co-authors question this practice and provide data to show that risk factors may not help predict those with an acute MI. The research method for the paper is a prospective cohort design with a total of 796 patients enrolled. The outcome of interest is 12-hour troponin T. Important is that the authors report that 12.2% of patients without a risk factor had an acute MI. There was not a significant difference in this MI rate and the rate for those with risk factors. This study supports other previous studies where patients often presented with chest pain and a lack of risk factors, but were found to have an acute MI. Lack of risk factors should not deter one from a full cardiac work-up when indicated.

The Framingham Heart Study, a long running longitudinal epidemiological study, showed that risk factors including hypertension, hyperlipidemia, tobacco smoking, diabetes mellitus, and family history of premature heart disease were associated with the development of coronary artery disease.[1] (This classic epidemiological study is one that all should have in their reference file. The study formed the basis for much of what today is thought to be important in cardiac disease management.) While the Framingham study only presented data regarding the development of coronary disease, many have used the same risk factors for determining risk of an acute MI during evaluation of acute chest pain or symptoms for cardiac ischemia. The authors of this study test the hypothesis that the Framingham risk factors can be used in the assessment of possible acute MI. They used a prospective cohort design and enrolled 796 total patients. The outcome measure of interest was an elevated 12-hour troponin T (≥0.035ng/ml) in a clinical setting consistent with possible MI (ischemic symptoms, ECG suggestive of MI, cardiac imaging consistent with MI). For this outcome measure, the authors found that 12.2% of those without risk factors were positive, 24.1% with one risk factor were positive, 19.0% with two risk factors were positive, 13.6% of those with three risk factors were positive, and 21.3% of those with four to five risk factors were positive. This study supports the findings of Jayes and co-authors in 1992 and Han and co-authors in 2007 that question the validity of using the epidemiologic risk markers identified in the Framingham study in the assessment of potential acute MI patients.[2,3] In interpretation of the data presented in this and previous papers, one must question a commonly held notion that cardiac risk factors may help identify a patient having an acute MI.

References

   1. Kannel et al. Am J Cardiology 1976, 38:46-51.
   2. Jayes et al. J of Clinical Epi 1992, 456:621-626.
   3. Han et a. Ann Emerg Med 2007, 49:145-152.