Related Experiment Video
Updated: Nov 6, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Early Dual-Antiplatelet Therapy at the Emergency Department Is Associated with Lower In-Hospital Major Adverse
Jen-Han Yang1,2, Hong-Mo Shih1,2, Yan-Cheng Pan2
1School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Insights
Initiating dual antiplatelet therapy (DAPT) within six hours for non-ST-segment-elevation myocardial infarction (NSTEMI) patients in the emergency department (ED) is linked to fewer major adverse cardiovascular events (MACE). Delays beyond six hours increase in-hospital MACE risk.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Dual antiplatelet therapy (DAPT) is a cornerstone treatment for non-ST-segment-elevation myocardial infarction (NSTEMI).
- Optimal timing for initiating DAPT in the Emergency Department (ED) for NSTEMI patients remains unclear.
- This study investigates the impact of DAPT initiation timing on NSTEMI patient outcomes.
Purpose of the Study:
- To determine the correlation between DAPT initiation timing in the ED and clinical outcomes in NSTEMI patients.
- To assess if early DAPT administration (within 6 hours) improves patient outcomes compared to delayed administration (beyond 6 hours).
Main Methods:
- Retrospective analysis of NSTEMI patients undergoing percutaneous coronary intervention (PCI) at China Medical University Hospital (2016-2019).
- Patients categorized into two groups based on DAPT administration: within 6 hours or beyond 6 hours of ED arrival.
- Primary outcome: in-hospital major adverse cardiovascular events (MACE). Secondary outcomes included ED return, readmission, and revascularization.
Main Results:
- 938 NSTEMI patients with PCI were included in the analysis.
- Patients receiving DAPT after 6 hours were older and had more comorbidities.
- Early DAPT initiation (within 6 hours) was associated with a significantly lower in-hospital MACE rate (3.52% vs. 8.37%, p=0.009).
- Delayed DAPT (beyond 6 hours) independently predicted higher in-hospital MACE risk (OR: 2.09, p=0.030).
Conclusions:
- Initiating DAPT beyond 6 hours post-ED arrival in NSTEMI patients is associated with an increased rate of in-hospital MACE.
- Early DAPT administration within 6 hours of ED arrival may be crucial for improving outcomes in NSTEMI patients undergoing PCI.
Background:
Dual antiplatelet therapy (DAPT) is a standard treatment in non-ST-segment-elevation myocardial infarction (NSTEMI). However, the timing of initiation of DAPT in the Emergency Department (ED) is not well established. The purpose of this study is to demonstrate the correlation between the different timings of DAPT initiation in ED and the outcomes in patients with NSTEMI.
Method:
We retrospectively collected data of patients who were diagnosed as NSTEMI in the ED of China Medical University Hospital during 2016 to 2019. All NSTEMI patients who required coronary stenting or ballooning were enrolled into the study, which means NSTEMI patients who received percutaneous coronary intervention (PCI) were included. The time interval between ED arrival and DAPT given was recorded. Patients were divided into 2 groups according to whether they received DAPT within 6 hours after arrival to the ED. The primary outcomes were in-hospital major adverse cardiovascular events (MACE). The secondary outcomes were unexpected return to the ED within 72 hours, readmission within 14 days, and revascularization procedures performed within the first 30 days.
Results:
938 NSTEMI patients with PCI were enrolled. Patients who received DAPT beyond 6 hours were relatively old (65.70 ± 14.13 versus 63.16 ± 13.31, p=0.014) and had relatively more comorbidities and higher Killip scores than those who received DAPT within 6 hours. The group that received DAPT within 6 hours had lower in-hospital MACE rate (3.52% versus 8.37%, p=0.009). Multivariate logistic regression showed the group beyond 6 hours was independently associated with higher risk for in-hospital MACE rate (OR : 2.09, 95% CI 1.07-4.07, p=0.030).
Conclusion:
Among patients with NSTEMI, DAPT beyond 6 hours after ED arrival have higher in-hospital MACE rate than those within 6 hours.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:30Acute Coronary Syndrome I: Introduction
01:26Angina IV: Management
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care