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Pattern and Outcome of Acute Non-ST-Segment Elevation Myocardial Infarction Seen in Adult Emergency Department of
Mohamed Abdelhameed1, Omran Hakim2, Awad Mohamed3
1Emergency Medicine, Bahri Teaching Hospital, Khartoum, SDN.
Insights
This study on non-ST elevation myocardial infarction (NSTEMI) found it predominantly affects older males, often presenting late to the emergency department. While most patients received standard care and survived, 25% were readmitted within 30 days.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Limited real-world data exists on emergency department (ED) care for non-ST elevation myocardial infarction (NSTEMI) despite investments in acute myocardial infarction (AMI) quality improvement.
- Understanding NSTEMI patient characteristics, management, and outcomes in the ED is crucial for optimizing care pathways.
Purpose of the Study:
- To describe the demographic characteristics of patients presenting with NSTEMI to the emergency department.
- To analyze the management strategies and in-hospital treatments administered to NSTEMI patients.
- To evaluate the 30-day outcomes, including readmission rates and mortality, for NSTEMI patients.
Main Methods:
- A prospective single-center study enrolled 40 NSTEMI patients from May to July 2021.
- Data collected included demographics, medical history, clinical presentation, laboratory results, ECG, echocardiogram, coronary angiography (CAG), management, medications, and 30-day outcomes.
- Standard diagnostic and management protocols were followed, with analysis of deviations and outcomes.
Main Results:
- NSTEMI was most common in males aged 56-70 years (60%), with diabetes (60%) and hypertension (50%) as major risk factors.
- A significant majority (72%) presented late (>6 hours) to the ED; 90% were Killip class I.
- Percutaneous coronary intervention (PCI) was the primary strategy (58%), with all patients receiving dual antiplatelet therapy and anticoagulation; 25% were readmitted within 30 days, with no mortality.
Conclusions:
- NSTEMI primarily impacts older males, often with delayed emergency care presentation and common cardiovascular risk factors like hypertension and diabetes.
- Standard NSTEMI protocols were generally followed, with PCI being the main intervention, but risk stratification was notably absent.
- While in-hospital and 30-day mortality was zero, a substantial 25% readmission rate highlights areas for potential improvement in post-discharge care.
Abstract:
Background Despite investments to improve the quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real-world trends in non-ST elevation myocardial infarction (NSTEMI) care in the emergency department (ED). We aimed to describe the characteristics, management, and outcomes of NSTEMI. Methods A prospective single-center study enrolled 40 NSTEMI patients in Alshaab Teaching Hospital during the period from May to July 2021. Data regarding demographics, medical history, clinical presentations, laboratory investigation, Killip classifications, electrocardiography (ECG), echocardiogram, diagnostic coronary angiography (CAG), management strategies, medications used, and 30-days outcomes were collected. Results Among 40 patients, NSTEMI was common in the age groups from 56 to 70 years (60%) and males (67.5%; p=0.002). Diabetes (n=24; 60%) and hypertension (n=20; 50%) were the major cardiovascular disease (CVD) risk factors. In most of the cases, 29 (72%) had a late presentation (>6 hours; p=0.0001). In Killip classifications, 36 (90%) patients were Killip class I and four (10%) were Killip class II (p=0.005). No patients underwent risk score assessment during a hospital stay. All patients had sinus rhythm in ECG and 28 (70%) had T-wave inversion. An echocardiogram was performed for 36 (90%) patients, among them six (16.7%) patients had LV systolic dysfunction (p=.003). The median ejection fraction was 52% (ranged from 25-75%). Diagnostic CAG was performed for 38 (95%) patients and a stent was inserted for 23 (58%) of them. The major final management strategy among our study group was PCI in 23 (58%) patients. All patients received aspirin, clopidogrel, parenteral anticoagulant, and ACEi/ARBs, 38 (95%) had statin, 28 (70%) were given PPI, and seven (17.5%) received diuretics. As for 30-day outcomes, all patients survived, but ten (25%) patients were readmitted, and no in-hospital or 30-days mortality occurred. Conclusion NSTEMI predominantly affected male and older patients. Most of them had a delayed presentation to ED. Hypertension and DM were the major risk factors. All patients were in sinus rhythm and the main ECG abnormality was a T-wave inversion. Most of the patients received standard NSTEMI protocol with exception of risk stratification. PCI was the major final management strategy used. Albeit no in-hospital or 30-days mortality occurred, 25% were readmitted.