"Short-Term Risk of Adverse Cardiac Events Among Emergency Department P" by Joshua C. Reynolds, John Oostema et al.
 

Short-Term Risk of Adverse Cardiac Events Among Emergency Department Patients Placed in an Observation Unit for Cardiac Testing.

Document Type

Article

Publication Date

2-11-2025

Publication Title

The Journal of emergency medicine

Abstract

BACKGROUND: Current practice favors estimating 6-week risk of major adverse cardiac events (MACE) to inform emergency department (ED) disposition for patients with suspected acute coronary syndrome. Expedited outpatient programs might alleviate costs of hospital-based evaluation of intermediate-risk patients, but require clear understanding of shorter-term risk.

OBJECTIVES: Estimate 72-hour risk of MACE (72-MACE) and other events among patients admitted to an observation unit (EDOU) for cardiac testing.

METHODS: Retrospective cohort study of EDOU subjects (January 1, 2022-June 30, 2023). The primary outcome was 72-MACE. Secondary outcomes were relevant treatments/events not included in MACE. We estimated risks of outcomes across HEART score strata, explored modeling to identify subpopulations with particularly low risk profiles, and constructed cumulative incidence curves for outcomes.

RESULTS: Among 1515 subjects, 85% had intermediate HEART scores and 1.4% (95% CI 0.8-2.1%) had 72-MACE. Low (0.7%; 95% CI 0.02-3.9%) and intermediate (1.3%; 95% CI 0.8-2.1%) HEART score subjects had more favorable risk profiles than high (3.8%; 95% CI 0.8-10.6%) HEART score subjects. Absence of highly suspicious symptoms (aOR 0.24; 95% CI 0.08-0.77) and presence of reassuring high-sensitivity troponin-T values (aOR 0.15; 95% CI 0.04-0.58) were associated with lower risks of 72-MACE. Among this subgroup, 0.7% (95% CI 0.3-1.4%) had 72-MACE. MACE occurred within 56 (IQR 31-122) hours and 100 (IQR 43-131) hours in the lowest-risk subgroup.

CONCLUSIONS: In a large cohort placed in EDOU, risks of 72-MACE were low, especially among subjects with low or intermediate HEART scores and a large subgroup with favorable combination of symptoms and troponin values.

Volume

S0736-4679

Issue

25

First Page

00045-9

DOI

10.1016/j.jemermed.2025.02.011

ISSN

0736-4679

PubMed ID

40383691

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