Limapichat Thanya, Kaewyingyong Sakarin
Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Open Access Emerg Med. 2022 Mar 10;14:109-117. doi: 10.2147/OAEM.S353630. eCollection 2022.
To study the association between prolonged emergency department length of stay (EDLOS) and in-hospital adverse events in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
In this retrospective cohort study, the medical records of 738 patients diagnosed with NSTE-ACS and admitted to the emergency department (ED) from 1 January 2013 to 31 December 2019 were reviewed. The patients were categorized into groups with EDLOS < 4 hours and EDLOS ≥ 4 hours, and baseline characteristics, clinical presentation, Killip classification, Global Registry of Acute Coronary Events score, investigations, use of the European Society of Cardiology (ESC) 0/1-hour and 0/3-hour algorithms, and treatments in the ED were compared between the groups. The associations of in-hospital adverse events with EDLOS were examined using univariate logistic regression.
Four hundred and twenty-three (57.3%) patients had an EDLOS of ≥ 4 hours, and the median (IQR) EDLOS was 4.48 hours (3.03, 6.20 hours). EDLOS ≥ 4 h was associated with a prolonged time to receive P2Y inhibitors and anticoagulants (P < 0.001). However, the two groups showed no significant differences in in-hospital adverse events (congestive heart failure [CHF], shock, stroke or transient ischemic attack [TIA], major bleeding, arrhythmia, recurrent myocardial infarction, death, and one or more adverse events). Nevertheless, a non-significant trend for a higher rate of adverse events (CHF, shock, major bleeding, arrhythmia, recurrent myocardial infarction, death, and one or more adverse events) with longer EDLOS was observed in the subgroup of patients who received diuretic or antiarrhythmic drugs, ventilator or bilevel positive airway pressure support, oxygen support, or inotropic/vasopressor drugs in the ED.
Prolonged EDLOS showed a significant association with longer times to receive P2Y inhibitors and anticoagulants. However, the EDLOS < 4 hour and EDLOS ≥ 4 hour groups of patients with NSTE-ACS showed no significant differences in the rates of in-hospital adverse events. Patients who receive cardiovascular medications in the ED or are on respiratory support should be hospitalized as soon as practically possible. Proper use of the 0/1-hour algorithm over the 0/3-hour algorithm without unnecessary repeated cardiac troponin tests in the ED could reduce the EDLOS in patients with NSTE-ACS.
研究非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者急诊科停留时间延长（EDLOS）与住院不良事件之间的关联。
在这项回顾性队列研究中，对2013年1月1日至2019年12月31日期间诊断为NSTE-ACS并入住急诊科（ED）的738例患者的病历进行了回顾。将患者分为EDLOS<4小时组和EDLOS≥4小时组，比较两组的基线特征、临床表现、Killip分级、急性冠状动脉事件全球注册评分、检查、欧洲心脏病学会（ESC）0/1小时和0/3小时算法的使用情况以及急诊科的治疗情况。采用单因素逻辑回归分析住院不良事件与EDLOS的关联。
423例（57.3%）患者的EDLOS≥4小时，EDLOS的中位数（IQR）为4.48小时（3.03，6.20小时）。EDLOS≥4小时与接受P2Y抑制剂和抗凝剂的时间延长相关（P<0.001）。然而，两组在住院不良事件（充血性心力衰竭[CHF]、休克、中风或短暂性脑缺血发作[TIA]、大出血、心律失常、再发性心肌梗死、死亡以及一种或多种不良事件）方面无显著差异。尽管如此，在急诊科接受利尿剂或抗心律失常药物、呼吸机或双水平气道正压支持、氧气支持或血管活性药物治疗的患者亚组中，观察到EDLOS越长，不良事件（CHF、休克、大出血、心律失常、再发性心肌梗死、死亡以及一种或多种不良事件）发生率越高的非显著趋势。
EDLOS延长与接受P2Y抑制剂和抗凝剂的时间显著延长相关。然而，NSTE-ACS患者中EDLOS<4小时组和EDLOS≥4小时组在住院不良事件发生率方面无显著差异。在急诊科接受心血管药物治疗或接受呼吸支持的患者应尽快住院。在急诊科正确使用0/1小时算法而非0/3小时算法，避免不必要的重复心肌肌钙蛋白检测，可缩短NSTE-ACS患者的EDLOS。
