Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease

作     者：Cláudio Marcelo Bittencourt das Virgens Laudenor Lemos Jr Márcia Noya-Rabelo Manuela Campelo Carvalhal Antonio Maurício dos Santos Cerqueira Junior Fernanda Oliveira de Andrade Lopes Nicole Cruz de Sá Jéssica Gonzalez Suerdieck Thiago Menezes Barbosa de Souza Vitor Calixto de Almeida Correia Gabriella Sant’Ana Sodré AndréBarcelos da Silva Felipe Kalil Beirao Alexandre Felipe Rodrigues Marques Ferreira Luís Cláudio Lemos Correia 

作者机构：Department of CardiologyHospital Sao Rafael Department of CardiologyHospital Português Bahiana School of Medicine and Public Health 

出 版 物：《World Journal of Cardiology》 (世界心脏病学杂志（英文版）（电子版）)

年 卷 期：2017年第9卷第3期

页      面：241-247页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Acute chest pain Clinical judgment Gestalt Coronary artery disease Acute coronary syndrome 

摘      要：AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease(CAD)in patients with acute chest *** We studied individuals who were consecutively admitted to our Chest Pain *** admission,investigators performed a standardized interview and recorded14 chest pain *** on these features,a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability,both numerically and *** the reference standard for testing the accuracy of gestalt,angiography was required to rule-in CAD,while either angiography or non-invasive test could be used to *** order to assess reproducibility,a second cardiologist did the same *** In a sample of 330 patients,the prevalence of obstructive CAD was 48%.Gestalt’s numerical probability was associated with CAD,but the area under the curve of0.61(95%CI:0.55-0.67)indicated low level of ***,categorical definition of typical chest pain had a sensitivity of 48%(95%CI:40%-55%)and specificity of 66%(95%CI:59%-73%),yielding a negligible positive likelihood ratio of 1.4(95%CI:0.65-2.0)and negative likelihood ratio of 0.79(95%CI:0.62-1.02).Agreement between the two cardiologists was poor in the numerical classification(95%limits of agreement=-71%to 51%)and categorical definition of typical pain(Kappa=0.29;95%CI:0.21-0.37).CONCLUSION Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.