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Complications in emergency department patients with acute coronary syndrome with contemporary care

Nilsson, Tsvetelina LU ; Mokhtari, Arash LU ; Sandgren, Jenny ; Lundager Forberg, Jakob LU ; Olsson de Capretz, Pontus LU and Ekelund, Ulf LU orcid (2024) In Cardiology
Abstract

INTRODUCTION: With the implementation of early reperfusion therapy, the number of complications in patients with acute coronary syndrome (ACS) has diminished significantly. However, ACS patients are still routinely admitted to units with high-level monitoring such as the coronary or intensive care unit (CCU/ICU). The cost of these admissions is high and there is often a shortage of beds. The aim of this study was to analyze the complications in contemporary ED patients with ACS and to map patient management.

METHODS: This observational study was a secondary analysis of data collected in the ESC-TROP trial (NCT03421873) that included 26545 consecutive chest pain patients ≥ 18 years at five Swedish emergency departments (ED).... (More)

INTRODUCTION: With the implementation of early reperfusion therapy, the number of complications in patients with acute coronary syndrome (ACS) has diminished significantly. However, ACS patients are still routinely admitted to units with high-level monitoring such as the coronary or intensive care unit (CCU/ICU). The cost of these admissions is high and there is often a shortage of beds. The aim of this study was to analyze the complications in contemporary ED patients with ACS and to map patient management.

METHODS: This observational study was a secondary analysis of data collected in the ESC-TROP trial (NCT03421873) that included 26545 consecutive chest pain patients ≥ 18 years at five Swedish emergency departments (ED). Complications were defined as the following within 30 days: Death, cardiac arrest, cardiogenic shock, pulmonary edema, severe ventricular arrhythmia, high-degree AV-block that required a pacemaker, and mechanical complications such as papillary muscle rupture, cardiac tamponade, or ventricular septum defects (VSD). Complications were identified via diagnosis and/or intervention codes in the database, and manual chart review was performed in cases with complications.

RESULTS: Of all 26545 patients, 2463 (9.3%) were diagnosed with ACS, and 151 of these (6.1%) suffered any complication within 30 days. Mean age was higher in patients with (79.2 years) than without (69.4 years) complications, and more were female (39.7% vs. 33.0%). Eighty-four (3.4% of all ACS patients) patients died, 33 (1.3%) had cardiac arrest, 22 (0.9%) respiratory failure, 13 (0.5%) high-degree AV block, 10 (0.4%) cardiogenic shock, 12 (0.5%) severe ventricular arrhythmia, and 2 each (<0.1%) had VSD or cardiac tamponade. Almost 30% of the complications were present already at the ED, and 40% of patients with complications were not admitted to the CCU/ICU. Only 80 (53%) of the patients with complications underwent coronary angiography and 62 (41%) were revascularized with PCI or CABG.

CONCLUSION: With current care, serious complications occurred in only 6 out of 100 ACS patients, and 2 of these complications were present already at the ED. Four out of ten ACS patients with complications were not admitted to the CCU/ICU and about half did not undergo coronary angiography. Further research is needed to improve risk assessment in ED ACS patients, which may allow more effective use of cardiac monitoring and hospital resources.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Cardiology
publisher
Karger
external identifiers
  • pmid:38599184
  • scopus:85196720751
ISSN
1421-9751
DOI
10.1159/000538637
language
English
LU publication?
yes
additional info
The Author(s). Published by S. Karger AG, Basel.
id
6372ad14-dbe1-4fc1-ab0b-d92df812b210
date added to LUP
2024-04-29 23:09:49
date last changed
2024-08-23 06:31:35
@article{6372ad14-dbe1-4fc1-ab0b-d92df812b210,
  abstract     = {{<p>INTRODUCTION: With the implementation of early reperfusion therapy, the number of complications in patients with acute coronary syndrome (ACS) has diminished significantly. However, ACS patients are still routinely admitted to units with high-level monitoring such as the coronary or intensive care unit (CCU/ICU). The cost of these admissions is high and there is often a shortage of beds. The aim of this study was to analyze the complications in contemporary ED patients with ACS and to map patient management.</p><p>METHODS: This observational study was a secondary analysis of data collected in the ESC-TROP trial (NCT03421873) that included 26545 consecutive chest pain patients ≥ 18 years at five Swedish emergency departments (ED). Complications were defined as the following within 30 days: Death, cardiac arrest, cardiogenic shock, pulmonary edema, severe ventricular arrhythmia, high-degree AV-block that required a pacemaker, and mechanical complications such as papillary muscle rupture, cardiac tamponade, or ventricular septum defects (VSD). Complications were identified via diagnosis and/or intervention codes in the database, and manual chart review was performed in cases with complications.</p><p>RESULTS: Of all 26545 patients, 2463 (9.3%) were diagnosed with ACS, and 151 of these (6.1%) suffered any complication within 30 days. Mean age was higher in patients with (79.2 years) than without (69.4 years) complications, and more were female (39.7% vs. 33.0%). Eighty-four (3.4% of all ACS patients) patients died, 33 (1.3%) had cardiac arrest, 22 (0.9%) respiratory failure, 13 (0.5%) high-degree AV block, 10 (0.4%) cardiogenic shock, 12 (0.5%) severe ventricular arrhythmia, and 2 each (&lt;0.1%) had VSD or cardiac tamponade. Almost 30% of the complications were present already at the ED, and 40% of patients with complications were not admitted to the CCU/ICU. Only 80 (53%) of the patients with complications underwent coronary angiography and 62 (41%) were revascularized with PCI or CABG.</p><p>CONCLUSION: With current care, serious complications occurred in only 6 out of 100 ACS patients, and 2 of these complications were present already at the ED. Four out of ten ACS patients with complications were not admitted to the CCU/ICU and about half did not undergo coronary angiography. Further research is needed to improve risk assessment in ED ACS patients, which may allow more effective use of cardiac monitoring and hospital resources.</p>}},
  author       = {{Nilsson, Tsvetelina and Mokhtari, Arash and Sandgren, Jenny and Lundager Forberg, Jakob and Olsson de Capretz, Pontus and Ekelund, Ulf}},
  issn         = {{1421-9751}},
  language     = {{eng}},
  month        = {{04}},
  publisher    = {{Karger}},
  series       = {{Cardiology}},
  title        = {{Complications in emergency department patients with acute coronary syndrome with contemporary care}},
  url          = {{http://dx.doi.org/10.1159/000538637}},
  doi          = {{10.1159/000538637}},
  year         = {{2024}},
}