Key result
Admission SBP >140 mmHg in ACS is linked to ~35% greater clinical improvement versus <120.
Why the study?
It was unclear what blood pressure level is beneficial to the improvement of ACS patients in the emergency department.
Does systolic blood pressure level predict clinical improvement and transfer to the general ward in patients with acute coronary syndrome in the emergency department?
Cohort (n=2,667)
No
Does systolic blood pressure level predict clinical improvement and transfer to the general ward in patients with acute coronary syndrome in the emergency department?
In patients presenting to the emergency department with acute coronary syndrome, an initial systolic blood pressure > 140 mmHg is associated with a higher likelihood of clinical improvement and transfer to a general ward.
Higher admission SBP was associated with ACS improvement in the ED; hypothesis-generating and should not yet change practice.
Background: Blood pressure affects the clinical outcome of acute coronary syndrome (ACS) patients. However, it is not clear what level of blood pressure is beneficial to the improvement of ACS patients in emergency department. The purpose of this study is to analyze the impact of systolic blood pressure (SBP) on ACS patient’ improvement and transfer of patient from emergency department Methods: A total of 2667 patients who were admitted to the Emergency Department of Chest Pain Center, Fujian Provincial Hospital due to chest pain from January 1, 2017 to March 31, 2020 were included in the study. Logistic regression was used to analyze the correlation between SBP and ACS patients’ improvement in the emergency department, and the predictive effect on the disease improvement was evaluated. The study also analyzed the impact of SBP on the improvement of different subgroups of patients in the emergency department. Results: In total, 592 (22.20%) out of 2667 patients were improved and transferred to the general ward. Multivariate logistic regression analysis found that SBP = 120–140 mmHg (OR = 0.700; 95% CI: 0.510–0.961; P = 0.027) was an independent predictor for the decreased likelihood of improvement of ACS patients from the emergency department; SBP > 140 mmHg (OR = 1.348; 95% CI: 1.000-1.817; P = 0.049), use of clopidogrel (OR = 1.924; 95% CI: 1.247–2.971; P = 0.003), non-ST-segment elevation myocardial infarction (NSTEMI) (OR = 2.683; 95% CI: 1.645–4.375; P < 0.001) and unstable angina (OR = 23.654; 95% CI: 15.415–36.297; P < 0.001) were all independent predictors for the increased likelihood of improvement of ACS patients in the emergency department. The area under curve (AUC) of the predictive efficacy of SBP, combined with ticagrelor, NSTEMI and unstable angina (UA) was 0.814 (95% CI: 0.795–0.833, P < 0.001). Conclusion: The study found that SBP = 120–140 mmHg was an independent predictor for the decreased likelihood of improvement of ACS patients from the emergency department, but SBP > 140 mmHg was an independent predictor for the increased likelihood of improvement of ACS patients. This correlation may be useful for doctors to make clinical decisions for ACS patients.
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Ke et al. (2021) conducted a cohort in Acute Coronary Syndrome (n=2,667). Systolic blood pressure >140 mmHg vs. Systolic blood pressure <120 mmHg was evaluated on Improvement in the emergency department (symptom relief and transfer to general ward) (OR 1.348, 95% CI 1.000-1.817, p=0.049). In patients with acute coronary syndrome, a systolic blood pressure >140 mmHg upon emergency department admission was associated with an increased likelihood of clinical improvement (OR 1.348) compared to <120 mmHg.
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