Abstract 12797: Characteristics and Outcomes of Emergency Department Patients Treated with Thienopyridines: Results from the NCDR®
Background: Over the last 10 years the AHA/ACC guidelines have evolved to recommend that patients with definite unstable angina or Non-ST segment elevation myocardial infarction (NSTEMI) receive dual antiplatelet therapy that may include a thienopyridine on presentation . to the hospital. Determinants and outcomes associated with the administration of thienopyridines in the emergency department (ED) have not been well characterized.
Methods: We examined thienopyridine use in 39,543 patients with NSTEMI included in the NCDR’s ACTION Registry®-GWTG™ (430 US hospitals) between1/2007 and 6/2010. Patients not seen initially in the ED, transferred in, not administered Clopidogrel or Prasugrel within 24 hours of presentation, or missing time data were excluded. We analyzed the patient demographics associated with ED administration and impact of ED thienopyridine administration on in-hospital outcomes.
Results: Of the cohort 9564 (24.2%) received a thienopyridine in the ED. Factors independently associated with the administration of a thienopyridine included ED were length of ED stay, elevated baseline troponin, and ST depression, transient ST elevation, or T wave inversion on the presenting electrocardiogram (Table). ED administration of a thienopyridine was not associated with adjusted in-hospital ACTION GWTG Major Bleeding (OR, 95% CI 0.91-1.09) or adjusted in-hospital mortality (1.09, 95% CI 0.93-1.28).
Conclusions: A quarter of patient with NSTEMI who were given a thienopyridine within 24 hours of presentation received it in the ED. ECG changes and higher troponin elevation are associated with thienopyridine administration in the ED. There was no association of ED thienopyridine administration with in-hospital major bleeding or mortality..
- © 2011 by American Heart Association, Inc.