Faculty Collaboration Database

ED administration of thienopyridines in non-ST-segment elevation myocardial infarction: results from the NCDR. Am J Emerg Med 2013 Jul;31(7):1005-11

Date

05/25/2013

Pubmed ID

23702070

Pubmed Central ID

PMC4045403

DOI

10.1016/j.ajem.2013.03.001

Scopus ID

2-s2.0-84880039660 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

OBJECTIVE: American Heart Association/American College of Cardiology guidelines recommend that patients with definite unstable angina or non-ST-segment elevation myocardial infarction (NSTEMI) receive dual antiplatelet therapy on presentation to the hospital when undergoing early invasive management or "as soon as possible" after admission when being managed conservatively. The guidelines do not specify whether these medications should be administered in the emergency department (ED). Our aim was to determine whether ED administration of a thienopyridine was associated with clinical outcomes among patients with NSTEMI.

METHODS: We examined thienopyridine use in 39454 patients with NSTEMI who received a thienopyridine within 24 hours of presentation in the National Cardiovascular Data Registry's Acute Coronary Treatment and Intervention Outcomes Network-Get With The Guidelines Registry from January 2007 to June 2010. Patients who were not seen initially in the ED, were transferred in, or were missing time data were excluded. We analyzed the association between ED administration of thienopyridines and outcomes and patient demographics.

RESULTS: Of the cohort receiving a thienopyridine within 24 hours, 9534 (24.2%) received it in the ED. Emergency department administration of a thienopyridine was not associated with in-hospital major bleeding (multivariable adjusted odds ratio, 0.99; 95% confidence interval, 0.91-1.09) or in-hospital mortality (adjusted 1.02; 95% confidence interval, 0.86-1.20). Independent predictors most strongly associated with ED thienopyridine administration were elevated troponin, ED length of stay, prior percutaneous coronary intervention, and initial electrocardiogram showing ischemic changes.

CONCLUSIONS: There was no association between ED thienopyridine administration and in-hospital major bleeding or mortality. Emergency department length of stay, electrocardiographic changes, and elevated troponin were associated with ED thienopyridine administration.

Author List

Diercks DB, Kontos MC, Hollander JE, Mumma BE, Holmes DN, Wiviott S, Saucedo JF, de Lemos JA

Author

Jorge Saucedo MD Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Drug Administration Schedule
Emergency Service, Hospital
Female
Hemorrhage
Hospital Mortality
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction
Odds Ratio
Piperazines
Platelet Aggregation Inhibitors
Prasugrel Hydrochloride
Registries
Retrospective Studies
Thiophenes
Ticlopidine
Treatment Outcome