Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Ste 350, Palo Alto, CA 94304, United States of America.
Department of Emergency Medicine, Stanford University, Palo Alto, CA, United States of America.
Am J Emerg Med. 2023 Aug;70:171-174. doi: 10.1016/j.ajem.2023.05.028. Epub 2023 May 26.
A majority of patients who experience acute coronary syndrome (ACS) initially receive care in the emergency department (ED). Guidelines for care of patients experiencing ACS, specifically ST-segment elevation myocardial infarction (STEMI) are well defined. We examine the utilization of hospital resources between patients with NSTEMI as compared to STEMI and unstable angina (UA). We then make the case that as NSTEMI patients are the majority of ACS cases, there is a great opportunity to risk stratify these patients in the emergency department.
We examined hospital resource utilization measure between those with STEMI, NSTEMI, and UA. These included hospital length of stay (LOS), any intensive care unit (ICU) care time, and in-hospital mortality.
The sample included 284,945 adult ED patients, of whom 1195 experienced ACS. Among the latter, 978 (70%) were diagnosed with NSTEMI, 225 (16%) with STEMI, and 194 with UA (14%). We observed 79.1% of STEMI patients receiving ICU care. 14.4% among NSTEMI patients, and 9.3% among UA patients. NSTEMI patients' mean hospital LOS was 3.7 days. This was shorter than that of non-ACS patients 4.75 days and UA patients 2.99. In-hospital mortality for NSTEMI was 1.6%, compared to, 4.4% for those with STEMI patients and 0% for UA. There are recommendations for risk stratification among NSTEMI patients to evaluate risk for major adverse cardiac events (MACE) that can be used in the ED to guide admission decisions and use of ICU care, thus optimizing care for a majority of ACS patients.
大多数经历急性冠状动脉综合征（ACS）的患者最初在急诊科（ED）接受治疗。针对 ACS 患者的护理指南，特别是 ST 段抬高型心肌梗死（STEMI），已有明确规定。我们比较了非 ST 段抬高型心肌梗死（NSTEMI）与 STEMI 和不稳定型心绞痛（UA）患者之间的医院资源利用情况。然后，我们认为 NSTEMI 患者是 ACS 患者中的大多数，因此有很大的机会在急诊科对这些患者进行风险分层。
我们检查了 STEMI、NSTEMI 和 UA 患者之间的医院资源利用情况。这些措施包括住院时间（LOS）、任何 ICU 护理时间和院内死亡率。
样本包括 284945 名成年 ED 患者，其中 1195 例患有 ACS。在后者中，978 例（70%）被诊断为 NSTEMI，225 例（16%）为 STEMI，194 例为 UA（14%）。我们观察到 79.1%的 STEMI 患者接受了 ICU 护理。NSTEMI 患者中有 14.4%，UA 患者中有 9.3%。NSTEMI 患者的平均住院时间为 3.7 天。这短于非 ACS 患者的 4.75 天和 UA 患者的 2.99 天。NSTEMI 患者的院内死亡率为 1.6%，而 STEMI 患者为 4.4%，UA 患者为 0%。对于 NSTEMI 患者，有风险分层的建议用于评估主要不良心脏事件（MACE）的风险，这些建议可在 ED 中用于指导入院决策和 ICU 护理的使用，从而优化大多数 ACS 患者的护理。
