Pattern and Outcome of Acute Non-ST-Segment Elevation Myocardial Infarction Seen in Adult Emergency Department of Al-Shaab Teaching Hospital: A prospective Observational Study in a Tertiary Cardiology Center

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.