Risk Factors for Poor Prognosis in Acute Coronary Syndrome Admitted in the Emergency Department: A Retrospective Cohort Study
DOI:
https://doi.org/10.1532/hsf.5153Keywords:
risk factor, acute coronary syndrome, poor prognosis, emergency departmentAbstract
Background: In the present study, we aimed to identify risk factors of poor prognosis for patients with acute coronary syndrome in the emergency department.
Methods: The study included 2667 patients, who were admitted to the Emergency Department of Chest Pain Center, Fujian Provincial Hospital, due to chest pain from January 1, 2017 to March 31, 2020. Logistic regression was used to identify factors of poor prognosis for patients with ACS in the ED. Receiver operating characteristic (ROC) curve was plotted to assess the performance of the multivariate logistic regression model. Subgroup analysis was used to analyze the difference of SBP in ACS patients with different characteristics.
Results: The final analysis included 2667 patients, of whom 2,057 patients (77.8%) had poor prognosis. STEMI (compared with UA) (OR=20.139; 95% CI:12.448-32.581; P < 0.001), NSTEMI (compared with UA) (OR=7.430; 95% CI:5.159-10.700; P < 0.001), respiratory rate ≥20 bpm (compared with <20 bpm) (OR=1.334; 95% CI: 1.060-1.679; P = 0.014), and use of antiplatelets (OR=1.557; 95% CI:1.181-2.053; P = 0.002) was associated with increased likelihood of poor prognosis for ACS patients in ED. SBP ≥140 mmHg (compared with<140mmHg) (OR=0.574; 95% CI: 0.477-0.690; P < 0.001) was associated with decreased likelihood of poor prognosis for ACS patients in the ED. The area under curve (AUC) of the predictive efficacy of logistic regression model was 0.825 (95% CI: 0.795-0.833, P < 0.001).
Conclusion: This study found that STEMI, NSTEMI, respiratory rate ≥20 bpm, and use of antiplatelets were associated with increased likelihood of poor prognosis for ACS patients in the ED. It also found that SBP≥140 was associated with decreased likelihood of poor prognosis. Our study may be useful for doctors to make clinical decisions for ACS patients.
References
Andreotti F, Testa L, Biondi-Zoccai GG, Crea F. 2006. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25,307 patients. Eur Heart J. 27(5):519-526.
Bangalore S, Messerli FH, Ou FS, Tamis-Holland J, Palazzo A, Roe MT, Hong MK, Peterson ED. 2009. Blood pressure paradox in patients with non-ST-segment elevation acute coronary syndromes: results from 139,194 patients in the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) quality improvement initiative. American Heart Journal. 157(3):525-531.
Bangalore S, Qin J, Sloan S, Murphy SA, Cannon CP. 2010. What is the optimal blood pressure in patients after acute coronary syndromes? Relationship of blood pressure and cardiovascular events in the PRavastatin OR atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial. Circulation. 122(21):2142-2151.
Barthel P, Wensel R, Bauer A, et al. 2013. Respiratory rate predicts outcome after acute myocardial infarction: a prospective cohort study. Eur Heart J. 34(22):1644-1650.
Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW, McFadden E, de Feyter PJ, Specchia G, Ruzyllo W. 2000. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation; recommendations of the Task Force of the European Society of Cardiology. European Heart Journal. 21(17):1406-1432.
Chan MY, Sun JL, Newby LK, Shaw LK, Lin M, Peterson ED, Califf RM, Kong DF, Roe MT. 2009. Long-term mortality of patients undergoing cardiac catheterization for ST-elevation and non-ST-elevation myocardial infarction. Circulation. 119(24):3110-3117.
Chen JY, He PC, Liu YH, et al. 2019. Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non-ST-Segment Elevation Acute Coronary Syndrome [published correction appears in JAMA Intern Med. Feb 1;179(2):280.
China NHaFPCoPsRo: China’s Health Statistical Yearbook. 2016. Beijing: Peking Union Medical College Press.
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, et al. 2020. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal.
Dawber TR, Moore FE, Mann GV. 2015. II. Coronary Heart Disease in the Framingham Study. International Journal of Epidemiology. 44(6):1767-1780.
Eagle KA, Lim MJ, Dabbous OH, Pieper KS, Goldberg RJ, Van de Werf F, Goodman SG, Granger CB, Steg PG, Gore JM, et al. 2004. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. Jama. 291(22):2727-2733.
Giustino G, Baber U, Stefanini GG, Aquino M, Stone GW, Sartori S, Steg PG, Wijns W, Smits PC, Jeger RV, et al. 2015. Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents. Am J Cardiol. 116(6):845-852.
Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van De Werf F, Avezum A, Goodman SG, Flather MD, et al. 2003. Predictors of hospital mortality in the global registry of acute coronary events. Archives of Internal Medicine. 163(19):2345-2353.
Hasdai D, Behar S, Wallentin L, Danchin N, Gitt AK, Boersma E, Fioretti PM, Simoons ML, Battler A. 2002. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). European Heart Journal. 23(15):1190-1201.
Hasdai D, Porter A, Rosengren A, Behar S, Boyko V, Battler A. 2003. Effect of gender on outcomes of acute coronary syndromes. Am J Cardiol. 91(12):1466-1469, a1466.
Kibos A, Guerchicoff A. 2011. Susceptibility genes for coronary heart disease and myocardial infarction. Acute Cardiac Care. 13(3):136-142.
Krumholz HM, Wang Y, Chen J, Drye EE, Spertus JA, Ross JS, Curtis JP, Nallamothu BK, Lichtman JH, Havranek EP, et al. 2009. Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006. Jama. 302(7):767-773.
Lee D, Goodman SG, Fox KA, DeYoung JP, Lai CC, Bhatt DL, Huynh T, Yan RT, Gallo R, Steg PG, et al. 2013. Prognostic significance of presenting blood pressure in non-ST-segment elevation acute coronary syndrome in relation to prior history of hypertension. American Heart Journal. 166(4):716-722.
Nikus KC, Eskola MJ, Virtanen VK, Harju J, Huhtala H, Mikkelsson J, Karhunen PJ, Niemelä KO. 2007. Mortality of patients with acute coronary syndromes still remains high: a follow-up study of 1188 consecutive patients admitted to a university hospital. Annals of Medicine. 39(1):63-71.
Park JS, Cha KS, Shin D, Lee DS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ, Lee SH, et al. 2015. Prognostic Significance of Presenting Blood Pressure in Patients With ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention. American Journal of Hypertension. 28(6):797-805.
Ponikowski P, Chua TP, Anker SD, et al. 2001. Peripheral chemoreceptor hypersensitivity: an ominous sign in patients with chronic heart failure. Circulation. 104(5):544-549.
Puelacher C, Gugala M, Adamson PD, et al. 2019. Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction. Heart. 105(18):1423-1431.
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, et al. 2016. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). European Heart Journal. 37(3):267-315.
Rogers WJ, Canto JG, Lambrew CT, Tiefenbrunn AJ, Kinkaid B, Shoultz DA, Frederick PD, Every N. 2000. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. Journal of the American College of Cardiology. 36(7):2056-2063.
Sibbing D, Aradi D, Jacobshagen C, et al. 2017. Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial. Lancet. 390(10104):1747-1757.
Steg PG, Goldberg RJ, Gore JM, Fox KA, Eagle KA, Flather MD, Sadiq I, Kasper R, Rushton-Mellor SK, Anderson FA. 2002. Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol. 90(4):358-363.
Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T, Zheng ZJ, Flegal K, O'Donnell C, Kittner S, et al. 2006. Heart disease and stroke statistics--2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 113(6):e85-151.
Zhang XC, Yu XZ, Chen FY, Zhu HD. 2019. Guidelines for rapid emergency diagnosis and treatment of acute coronary syndrome. Journal of Clinical Emergency (China). 44:253-262.
