Occurrence of Severe Cardiac Rhythm and Conduction Disturbances in Emergency Department Patients With Non-ST Elevation Acute Coronary Syndrome

N/ANot Yet RecruitingNCT07112547

University Hospital, Strasbourg, France500 enrolled

Overview

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).

Study Type

OBSERVATIONAL

Enrollment

500

Conditions

Acute Coronary Syndrome Without ST Elevation on Electrocardiogram Acute Coronary Syndromes (ACS)Myocardial Infarction, Unstable Angina Pectoris, Sudden Cardiac Death, Stroke, Peripheral Artery Disease

Outcomes

Primary Outcomes

Occurrence of Serious Rhythm or Conduction Disturbances in the Emergency Department

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.

Time frame: During emergency department stay, assessed up to 24 hours

Secondary Outcomes

Incidence of Non-Life-Threatening Arrhythmias or Conduction Disorders in the Emergency Department

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

Time frame: During emergency department stay, assessed up to 24 hours

Number of patients presenting complications prior to a confirmed diagnosis of NSTE-ACS

Occurrence of complications such as syncope, presyncope, cardiogenic shock, respiratory distress, or rhythm/conduction disturbances before final diagnosis of NSTE-ACS.

Time frame: Prior to establishing a confirmed diagnosis of NSTE-ACS in the ED, assessed up to 12 hours

Duration of Stay in the Emergency Department

Time spent in the emergency department and in the short-stay unit (UHCD) before transfer or discharge.

Time frame: From ED admission to hospital admission, discharge, or UHCD discharge; up to 72 hours

Number of patients by disposition at emergency department discharge (home vs. hospital admission and type of admitting service

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).

Time frame: At the time of emergency department discharge or transfer, assessed up to 72 hours from ED admission

Duration of Hospitalization

Overall length of stay for hospitalized patients

Time frame: From hospital admission to hospital discharge, assessed up to 14 days.

Number of patients with all-cause mortality or 5-point major adverse cardiovascular events (5P-MACE) at 30 days

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.

Time frame: Day 30 post-ED management

Clinical features : weight

Weight (kg)