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Abstract：
Background Despite investments to improve the quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real-world trends in non-ST elevation myocardial infarction (NSTEMI) care in the emergency department (ED). We aimed to describe the characteristics, management, and outcomes of NSTEMI. Methods A prospective single-center study enrolled 40 NSTEMI patients in Alshaab Teaching Hospital during the period from May to July 2021. Data regarding demographics, medical history, clinical presentations, laboratory investigation, Killip classifications, electrocardiography (ECG), echocardiogram, diagnostic coronary angiography (CAG), management strategies, medications used, and 30-days outcomes were collected. Results Among 40 patients, NSTEMI was common in the age groups from 56 to 70 years (60%) and males (67.5%; p=0.002). Diabetes (n=24; 60%) and hypertension (n=20; 50%) were the major cardiovascular disease (CVD) risk factors. In most of the cases, 29 (72%) had a late presentation (>6 hours; p=0.0001). In Killip classifications, 36 (90%) patients were Killip class I and four (10%) were Killip class II (p=0.005). No patients underwent risk score assessment during a hospital stay. All patients had sinus rhythm in ECG and 28 (70%) had T-wave inversion. An echocardiogram was performed for 36 (90%) patients, among them six (16.7%) patients had LV systolic dysfunction (p=.003). The median ejection fraction was 52% (ranged from 25-75%). Diagnostic CAG was performed for 38 (95%) patients and a stent was inserted for 23 (58%) of them. The major final management strategy among our study group was PCI in 23 (58%) patients. All patients received aspirin, clopidogrel, parenteral anticoagulant, and ACEi/ARBs, 38 (95%) had statin, 28 (70%) were given PPI, and seven (17.5%) received diuretics. As for 30-day outcomes, all patients survived, but ten (25%) patients were readmitted, and no in-hospital or 30-days mortality occurred. Conclusion NSTEMI predominantly affected male and older patients. Most of them had a delayed presentation to ED. Hypertension and DM were the major risk factors. All patients were in sinus rhythm and the main ECG abnormality was a T-wave inversion. Most of the patients received standard NSTEMI protocol with exception of risk stratification. PCI was the major final management strategy used. Albeit no in-hospital or 30-days mortality occurred, 25% were readmitted.
摘要：
背景：尽管投资于提高急性心肌梗死（AMI）患者的急诊护理质量，很少有研究描述了国家，急诊科（ED）非ST段抬高型心肌梗死（NSTEMI）护理的现实趋势。我们旨在描述这些特征，管理,以及NSTEMI的结果。方法一项前瞻性单中心研究纳入Alshaab教学医院2021年5月至7月期间的40例NSTEMI患者。有关人口统计的数据，病史,临床表现,实验室调查,Killip分类,心电图(ECG),超声心动图,诊断性冠状动脉造影(CAG),管理策略，使用的药物，并收集30天的结局.结果40例患者中,NSTEMI在56至70岁（60％）和男性（67.5％；p=0.002）的年龄组中很常见。糖尿病（n=24；60％）和高血压（n=20；50％）是主要的心血管疾病（CVD）危险因素。在大多数情况下,29例(72%)出现延迟(>6小时;p=0.0001)。在Killip分类中,36例（90％）患者为KillipI级，4例（10％）为KillipII级（p=0.005）。没有患者在住院期间进行风险评分评估。所有患者心电图均有窦性心律，其中28例（70％）有T波倒置。对36例（90%）患者进行了超声心动图检查，其中6例(16.7%)患者存在左心室收缩功能障碍(p=.003).中位射血分数为52%（25-75%）。对38例（95％）患者进行了诊断性CAG，其中23例（58％）患者插入了支架。我们研究组的主要最终管理策略是23例（58％）患者的PCI。所有患者均接受阿司匹林,氯吡格雷,肠胃外抗凝剂，和ACEi/ARB，38（95%）有他汀类药物，28例(70%)给予PPI，七人(17.5%)接受利尿剂治疗。至于30天的结果，所有患者都存活了下来,但有10名（25%）患者再次入院，并且没有发生住院或30天死亡。结论NSTEMI主要影响男性和老年患者。他们中的大多数人都延迟了向ED的陈述。高血压和DM是主要的危险因素。所有患者均为窦性心律，主要心电图异常为T波倒置。除风险分层外，大多数患者接受了标准的NSTEMI方案。PCI是主要的最终管理策略。尽管没有住院或30天死亡发生，25%被重新接纳。
