| Objective: Coronary heart disease is a common disease. In recent years, withthe improvement of living standard, great changes have taken place in people’s dietstructure and the life mode. The incidence of coronary heart disease and mortalityrates continue to increase, has become the first diseases leading to death. Coronaryheart disease include acute coronary syndrome and chronic coronary artery disease,for which the primary symptom is chest pain.The chest pain is the common onecomplaint of CHD. But the chest pain is diverse and complex. It leads difficult forclinicians in the diagnosis and distinction. It is easily misdiagnosed, Coronaryangiography is the "gold standard" for the diagnosis of coronary artery disease, can befound directly the degree of stenosis of the coronary artery lumen. As a kind ofinvasive and expensive check, use was limited to basic hospital. However, in thegeneral hospital, the positive rate of coronary angiography in lower level. CHD oftencomplicates with risk factors： smoking, hypertension, diabetes dyslipidemia etc.. Weselected patients who be suspected CHD with atypical angina performance, throughinterrogation and physical examination and simple laboratory examinations,collection their clinical data and filtering out the main risk factors. Based risk scoreestablished scoring system according to the score, the patients were divided into lowrisk group and high risk group. Suggest the patients with low risk for coronary CTexamination. The positive patients underwent coronary angiography.Negativepatients can basically rule out coronary heart disease. The patients with high risk, candirectly accept coronary angiography. Our aim is to establish a simple and easy to operate scoring system for the patient who was suspected coronary artery disease withatypical angina.And to test its practical value in the clinicalMethods: The experiment was divided into three parts. The first part: Byretrospectively study a database of3420patients with atypical angina, collect thierclinical data and select risk factor, by logistic regression analysis and then risk factorsare assigned according to OR values. Risk points are calculated.Use it to analyzecorrelation between risk points and prevalence of CHD. By calculating the area underthe receiver operating characteristic (ROC) curve to test the application efficiency ofdiagnostic score scheme.The second part:A prospective study which collected4763cases from outpatient, emergency and inpatient, who was suspected coronary heartdisease with atypical angina. Based on ABCDDS score, patients were divided intohigh-risk group (score>5points) and the low-risk group (points≤5points). Thepatients of high-risk group will undergo coronary angiography and the low-risk groupwill undergo coronary CT. The patients with positive of coronary CT examination willundergo coronary angiography. The patients with negative results can be ruled outcoronary artery disease. We use coronary angiography to examine the feasibility andaccuracy of ABCDDS rating scheme. Part third: Based on the results of coronaryangiography, low-risk patients were divided into groups of non-coronary heart disease,coronary heart disease. We retrospectively analyzed the difference between the twogroups at baseline. Risk factors for coronary heart disease were elected in low-riskgroup. Select high-risk group of patients who coronary angiography is negative a totalof360people. Trace its final diagnosis, explore misdiagnosed as coronary heartdisease.Results：The first part:Age，male，smoking and medical history,(such ashypertension， diabetes mellitus and dyslipidemia) are the risk factors for thepopulation with atypical angina．To take the first letters of six risk factors and thescoring system was named ABCDDS scheme．Specific score is: OR value <2.0denoted by1point,2.0-2.5counts as2points,>2.5denoted by3points. Age groups:<50years recorded as0point,≥50years of age and <65years record of2points,≥ 65-year-old record of3points.For diagnostic score scheme，the area under the ROCcurve is0.72with a high statistical significance. Sensitivity=88.9%, specificity=63.12%accuracy rate=69.01%. Risk factors points in the range of0-11. Withincreasing of points, the greater of the likelihood of suffering from coronary heartdisease. The incidence of coronary heart disease and risk score was positivelycorrelated. Linear equation y=0.81x+19.06. We found that the higher of the riskscore that the higher of coronary artery lesions, the higher the average total score ofCHD and the proportion of three lesions are.When risk score is≥6points andsuggests the presence of coronary artery disease. Second part: based on ABCCDSscoring system patients were divided into high-risk group and low-risk group. For thelow-risk group (≤5points) have done coronary CT examination, which1922ca seswere negative. The proportion of negative accounted for78.5%. Because of thespecificity of coronary CT diagnosis of more than98%.Therefore, such patients canexclude the diagnosis of coronary artery disease. The other526cases (21.5%)underwent coronary angiography that a total of477cases Coronary angiography inpatients with positive. A total of2841patients underwent coronary angiography. Theoverall positive rate was84.4%. So the misdiagnosis rate of coronary heart diseasefell to15.6%. Increase the rate of positive diagnosis of coronary angiography. Partthird: in low-risk group of patients, age and history of diabetes were the risk factor forcoronary heart disease. Variant angina, Cardiac Syndrome X, and myocardial bridgeeasily were misdiagnosed as coronary heart disease in the high-risk patients.Conclusion:(1) Age，male，smoking and medical history,(such as hypertension，diabetesmellitus and dyslipidemia) are the risk factors for the population with atypical angina．(2)Diagnostic scoring scheme is simple and practically. When risk score is≥6points,it suggests the presence of CHD．(3) ABCDDS score can reduce the misdiagnosis rate of coronary heart disease,improve coronary angiography positive diagnosis rate.(4) In the low-risk group, even the elderly or diabetic point≤5, but also alert tothe possibility of coronary heart disease. Variant angina, Cardiac Syndrome X, and myocardial bridge easily were misdiagnosed as coronary heart disease in the high-riskpatients. |
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