Yang Jen-Han, Shih Hong-Mo, Pan Yan-Cheng, Chang Shih-Sheng, Li Chi-Yuan, Yu Shao-Hua
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
Cardiol Res Pract. 2021 Apr 22;2021:5571822. doi: 10.1155/2021/5571822. eCollection 2021.
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.
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.
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, =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%, =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, =0.030).
Among patients with NSTEMI, DAPT beyond 6 hours after ED arrival have higher in-hospital MACE rate than those within 6 hours.
双联抗血小板治疗（DAPT）是非ST段抬高型心肌梗死（NSTEMI）的标准治疗方法。然而，急诊科（ED）开始DAPT的时机尚未明确。本研究的目的是证明急诊科开始DAPT的不同时机与NSTEMI患者预后之间的相关性。
我们回顾性收集了2016年至2019年在中国医科大学医院急诊科被诊断为NSTEMI的患者的数据。所有需要冠状动脉支架置入或球囊扩张的NSTEMI患者均纳入本研究，即包括接受经皮冠状动脉介入治疗（PCI）的NSTEMI患者。记录从到达急诊科到给予DAPT的时间间隔。根据患者在到达急诊科后6小时内是否接受DAPT分为两组。主要结局是院内主要不良心血管事件（MACE）。次要结局是72小时内意外返回急诊科、14天内再次入院以及前30天内进行的血运重建手术。
938例接受PCI的NSTEMI患者被纳入研究。在到达急诊科6小时后接受DAPT的患者相对年龄较大（65.70±14.13对63.16±13.31，P=0.014），并且与在6小时内接受DAPT的患者相比，合并症相对更多，Killip评分更高。在6小时内接受DAPT的组院内MACE发生率较低（3.52%对8.37%，P=0.009）。多因素逻辑回归显示，6小时后组与院内MACE发生率较高独立相关（OR：2.09，95%CI 1.07-4.07，P=0.030）。
在NSTEMI患者中，到达急诊科6小时后进行DAPT的患者院内MACE发生率高于6小时内进行DAPT的患者。
