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
Recommended Citation
Reynolds JC, Oostema JA, Sierzant C, Sherwin K, Beels K, Clegg A et al Short-term risk of adverse cardiac events among emergency department patients placed in an observation unit for cardiac testing. J Emerg Med. 2025 Feb 11:S0736-4679(25)00045-9. doi: 10.1016/j.jemermed.2025.02.011. Epub ahead of print. PMID: 40383691.
DOI
10.1016/j.jemermed.2025.02.011
ISSN
0736-4679
PubMed ID
40383691