Acute Coronary Syndromes (ACS), Acute Coronary Syndrome Without ST Elevation on Electrocardiogram, Myocardial Infarction, Unstable Angina Pectoris, Sudden Cardiac Death, Stroke, Peripheral Artery Disease
Conditions
Keywords
Non-ST Segment Elevation Acute Coronary Syndrome, Cardiac Arrhythmias, Heart Conduction System Disease, Hospital Emergency Service, Electrocardiographic monitoring, Cardiovascular diseases
Brief summary
Cardiovascular diseases are the leading cause of death worldwide. Among them, coronary artery disease-especially in its acute form, known as acute coronary syndrome (ACS)-is the most frequent cause of cardiovascular death. There are two main types of ACS: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS). While the occurrence of serious heart rhythm and conduction disturbances is well established in STEMI, these complications are believed to be much less frequent in NSTE-ACS. However, their actual frequency in this population remains unclear due to limited studies, especially in emergency settings. The main purpose of this study is to estimate the frequency of serious rhythm and conduction disorders in patients presenting with NSTE-ACS in emergency departments. The hypothesis is that these events are rare in this population and may not justify routine continuous cardiac monitoring for all such patients, as currently recommended. Secondary objectives include identifying risk factors for these complications, estimating their frequency during hospitalization, assessing the frequency of minor rhythm and conduction disorders, evaluating care times and patient flow in emergency departments, and assessing patient outcomes up to 30 days-including hospitalizations, length of stay, discharge disposition, all-cause mortality, and the occurrence of five major adverse cardiovascular events (5-point MACE).
Interventions
None listed
Sponsors
University Hospital, Strasbourg, France
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult (≥ 18 years old) patient admitted to the emergency department * Able to understand the information provided * Diagnosis of non-ST segment elevation ACS established according to the lastest guidelines from the European Society of Cardiology and the 4th Universal Definition of myocardial infarction * No objection to participation in the study after receiving appropriate information
Exclusion criteria
* Patients subject to legal protection * Patient with cognitive impairment * Myocardial injury and/or symptoms attributable to Takotsubo syndrome, myocarditis, pericarditis, or acute heart failure * Clinical evidence suggestive of type 2 myocardial infarction, including acute anemia with hemoglobin \< 10 g/dL, sepsis, acute hypoxemic respiratory failure
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Occurrence of Serious Rhythm or Conduction Disturbances in the Emergency Department | During emergency department stay, assessed up to 24 hours | Occurrence of at least one serious rhythm or conduction disturbance during emergency department management, including: sustained ventricular tachycardia (VT), ventricular fibrillation (VF), torsades de pointes, high-degree conduction disorders (Mobitz type II AV block, third-degree AV block, trifascicular block), pulseless electrical activity (PEA), and asystole. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Non-Life-Threatening Arrhythmias or Conduction Disorders in the Emergency Department | During emergency department stay, assessed up to 24 hours | Occurrence of arrhythmias not immediately life-threatening: atrial fibrillation or flutter, Mobitz type I AV block, first-degree AV block, sinus node dysfunction, or non-sustained VT |
| Number of patients presenting complications prior to a confirmed diagnosis of NSTE-ACS | Prior to establishing a confirmed diagnosis of NSTE-ACS in the ED, assessed up to 12 hours | Occurrence of complications such as syncope, presyncope, cardiogenic shock, respiratory distress, or rhythm/conduction disturbances before final diagnosis of NSTE-ACS. |
| Duration of Stay in the Emergency Department | From ED admission to hospital admission, discharge, or UHCD discharge; up to 72 hours | Time spent in the emergency department and in the short-stay unit (UHCD) before transfer or discharge. |
| Number of patients by disposition at emergency department discharge (home vs. hospital admission and type of admitting service | At the time of emergency department discharge or transfer, assessed up to 72 hours from ED admission | Disposition of patients: home discharge or hospital admission. For admitted patients, type of service recorded (ICU, coronary care unit, cardiology, internal medicine, short-stay unit, or other). |
| Duration of Hospitalization | From hospital admission to hospital discharge, assessed up to 14 days. | Overall length of stay for hospitalized patients |
| Clinical data : temperature | From admission to discharge from hospital, assessed up to 7 days | Temperature (°C) |
| Number of patients with all-cause mortality or 5-point major adverse cardiovascular events (5P-MACE) at 30 days | Day 30 post-ED management | This composite outcome includes the number of participants who experience either all-cause death or at least one of the following 5-point major adverse cardiovascular events (5P-MACE) within 30 days: 1. Cardiovascular death 2. Myocardial infarction 3. Stroke or transient ischemic attack (TIA) 4. Hospitalization for heart failure 5. Coronary or peripheral revascularization Outcome events will be assessed through medical records and/or follow-up phone call if needed. |
| Clinical features : weight | From admission to discharge from hospital, assessed up to 7 days | Weight (kg) |
| Clinical features : height | From admission to discharge from hospital, assessed up to 7 days | Height (cm) |
| Clinical features : heart rate | From admission to discharge from hospital, assessed up to 7 days | Heart rate (bpm) |
| Clinical data : blood and arterial pressure | From admission to discharge from hospital, assessed up to 7 days | systolic/diastolic blood pressure (mmHg) and mean arterial pressure (mmHg) |
| clinical data : capillary blood glucose | From admission to discharge from hospital, assessed up to 7 days | Capillary blood glucose g/L |
| Cardiovascular history and risk factors | From admission to discharge from hospital, assessed up to 7 days | Cardiovascular history and risk factors : questionnaire on medical history and prior related treatments (anticoagulant, antiplatelet agent, analgesic, oxygen therapy, statin, beta blocker, ACE inhibitor, angiotensin II receptor blocker). |
| Biological workup : troponin | From admission to discharge from hospital, assessed up to 7 days | Troponin (1st, 2nd ; 3rd measurement) (ng/mL) |
| Biological work-up : NT-proBNP | From admission to discharge from hospital, assessed up to 7 days | NT-proBNP (ng/mL) |
| Biological workup : hemoglobin | From admission to discharge from hospital, assessed up to 7 days | hemoglobin (g/dL) |
| Biological workup : BNP | From admission to discharge from hospital, assessed up to 7 days | BNP (ng/mL) |
| Biological workup : platelets count | From admission to discharge from hospital, assessed up to 7 days | platelets (10\^9/L or Giga/L) |
| Biological workup : mean corpuscular volume | From admission to discharge from hospital, assessed up to 7 days | mean corpuscular volume (fL or µm3) |
| Biological workup : potassium | From admission to discharge from hospital, assessed up to 7 days | potassium (mmol/L) |
| Biological workup : creatinine | From admission to discharge from hospital, assessed up to 7 days | creatinine (µmol/L) |
| Biological workup : creatinine clearance | From admission to discharge from hospital, assessed up to 7 days | creatinine clearance (mL/min/1,73m2) |
| Electrocardiogram (ECG) | From admission to discharge from hospital, assessed up to 7 days | Electrocardiogram (ECG) : presence or absence of ST elevation, T wave inversion, pathological |
| Clinical data : oxygen saturation | From admission to discharge from hospital, assessed up to 7 days | peripheral capillary oxygen saturation (%) |
Countries
France
Contacts
Primary ContactSabrina GARNIER-KEPKA, Dr
Backup ContactValérie WILME, Dr
Outcome results
None listed