在隨後的主編評論中，來自佛州Jacksonville梅約診所心臟血管疾病部門的Thomas C. Gerber博士及其同事們表示，該族群過去有心肌梗塞的盛行率為22%，因此顯然非低風險族群的這些病患，之後轉介給心臟科評估的頻率並非意料之外。主編們也指出，在收集資料的那段時間，心臟生化標記並不普及，部分有非心因性胸痛臨床診斷的患者，事實上是罹患了急性冠心症。
這項研究由TAP藥廠（現在是武田藥廠北美分公司的分公司）。
Gastrointestinal Workup Occurs Infrequently in Patients With Noncardiac Chest Pain
By Emma Hitt, PhD
Medscape Medical News
April 21, 2010 — Relatively few gastrointestinal (GI) consultations and tests are performed in patients with noncardiac chest pain (NCCP), but a sizeable percentage receive cardiology consultation and workup, and not a small number suffer cardiac death at a later time, according to a report in the April issue of the Mayo Clinic Proceedings. Screening the NCCP population for cardiac risk factors is recommended by the researchers.
"Little is known about health care utilization after a diagnosis of NCCP," note Michael D. Leise, MD, from the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, New York, and colleagues.
For the purposes of the study, NCCP was defined as noncardiac chest pain presenting as substernal chest pain in the absence of significant epicardial coronary artery stenoses. "[Gastroesophageal reflux disease] is the most prevalent cause of NCCP, accounting for up to 60% of cases," the authors explain.
Dr. Leise and colleagues sought to determine the percentage of GI consultations obtained, as well as the type and frequency of both GI and cardiac testing performed and the incidence of cardiac related deaths in patients with a diagnosis of NCCP.
Participants were derived from a cohort of Olmsted County, Minnesota, residents (via the Rochester Epidemiology Project) presenting to the emergency department (ED) with chest pain between January 1, 1985, and December 31, 1992. A total of 320 patients with NCCP of unknown origin or secondary to GI diagnoses were included.
Of the patients, 49% were evaluated in the ED, 42% had repeated cardiology evaluations, and only 15% were assessed by a gastroenterologist after their initial diagnosis. A total of 38% underwent esophagogastroduodenoscopy, but only 4% underwent manometry; 2% underwent pH probes.
"Although repeated ED visits for chest pain are to be expected, the number of repeated cardiology evaluations and the paucity of GI consultations are surprising," the authors note.
The researchers also sought to determine the number of cardiac deaths in this group. Survival free of cardiac death was 93.7% at 10 years and 88.1% at 20 years for the subset of patients with NCCP of unknown origin compared with 90.2% at 10 years and 84.8% at 20 years in the subset of patients with NCCP in addition to a GI disorder.
"Although the total sample did not display a significantly increased frequency of death compared with what would be expected in this community, a substantial number of cardiac deaths occurred in an NCCP population," the authors write.
The researchers suggest that cardiac death in patients with NCCP may relate to overlapping risk factors for gastroesophageal reflux disease and coronary artery disease. "Until cardiac death in this population is better understood, it is prudent to screen for cardiac risk factors such as hypertension, hypercholesterolemia, and diabetes mellitus and aggressively manage these comorbid conditions when present."
In a related editorial, Thomas C. Gerber, MD, PhD, from the Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida, and colleagues note that the cohort of patients had a 22% prevalence of prior myocardial infarction, and therefore was "clearly not a low-risk group, and the frequency of subsequent referral for cardiology evaluation is not unexpected." The editorialists also point out that cardiac biomarkers were not widely available at the time of the data collection, and that "it is conceivable that some of the patients with a clinical diagnosis of noncardiac chest pain in fact had an [acute coronary syndrome]."
Support was provided by TAP Pharmaceutical Products (now part of Takeda Pharmaceuticals North America).
