Management of acute coronary syndrome in emergency departments: a cross sectional multicenter study (Tunisia)

Abstract

BackgroundWe aimed to describe diagnosed acute coronary syndrome (ACS) and its care management and outcomes in emergency departments (EDs) and to determine related cardiovascular risk factors (CVRFs).MethodsWe conducted a cross sectional multicenter study that included 1173 adults admitted to EDs for acute chest pain (ACP) in 2015 at 14 sites in Tunisia. Data included patients’ baseline characteristics, diagnosis, treatment and output.ResultsACS represented 49.7% of non-traumatic chest pain [95% CI: 46.7–52.6]; 74.2% of ACS cases were unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI). Males represented 67.4% of patients with ACS (p < 0.001). The median age was 60 years (IQR 52–70). Emergency medical service transportation was used in 11.9% of cases. The median duration between chest pain onset and ED arrival was two hours (Inter quartile ranges (IQR) 2–4 h). The age-standardized prevalence rate was 69.9/100,000 PY; the rate was 96.24 in men and 43.7 in women. In the multivariable analysis, CVRFs related to ST segment elevation myocardial infarction were age correlated to sex and active smoking. CVRFs related to UA/NSTEMI were age correlated to sex, familial and personal vascular history and type 2 diabetes. We reported 27 cases of major adverse cardiovascular events (20.0%) in patients with STEMI and 36 in patients with UA/NSTEMI (9.1%).ConclusionHalf of the patients consulting EDs with ACP had ACS. Emergency medical service transportation calls were rare. Management delays were acceptable. The risk of developing an UA/NSTEMI was equal to the number of CVRFs + 1. To improve patient outcomes, it is necessary to increase adherence to international management guidelines.

Acute coronary syndrome treatment delay in low to middle-income countries: A systematic review

“…In another study, Mohan [30] reported that although 96% of patients were aware of ambulance services, only 5.3% of patients used an ambulance for transport. In several other studies, presenting directly to a tertiary facility significantly reduced mean treatment time versus those who were initially seen at a general hospital or by a primary clinician [19] , [20] , [21] , [26] , [27] , [28] , [34] , [35] , [37] , [41] . There was general agreement among studies that a lack of available reperfusion centers outside of major urban areas, limited diagnostic resources (EKG, cardiac enzymes) and adequately trained clinicians to recognize ACS prolonged symptom onset to treatment time [21] , [26] , [27] , [28] , [30] , [31] , [42] , [43] .…”

“…In the majority of studies, male gender and younger age were associated with earlier treatment of ACS compared to females and older adults, respectively [19] , [23] , [31] , [33] , [34] , [35] . Several studies reported however, that there were no differences in treatment for ACS due to either gender or age characteristics.…”

“…In a study of 100 patients in India with no prior histor676of ischemic heart disease or ACS, the median treatment delay time was 24 h, and only 27% reached the hospital within 6 h; 65% of this number were STEMI [39] . Several studies reported that STEMI patients present earlier for treatment than NSTEMI or UA [27] , [28] , [31] , [34] , [39] , [40] .…”

“…Female gender, being uneducated, self-transportation or referral from another hospital, atypical chest pain and history of hypertension were associated with significantly higher delay times. *** ** ** Good Sriha et al, 2018 [34] Cross-sectional, descriptive. 14 emergency departments (8 academic centers, 7 regional) in Tunisia 1173 Mean age was 60 years, 67.4% were males; the majority were UA/NSTEMI (74.2%) To describe ACS prevalence and management in emergency departments (EDs).…”

Effect of Elevated Pulmonary Artery Systolic Pressure on Short-Term Prognosis in Patients With Acute Myocardial Infarction

“…Many studies had confirmed that this variable has a significant effect on the long-term prognosis of patients with AMI. 30 –32 The higher the Killip grading, the worse the prognosis of patients with AMI. In this study, with the increase in PASP levels, the proportion of patients with Killip I grades gradually decreased, and the proportion of patients with grade II to IV gradually increased.…”