Does the coronary care unit improve prognosis of patients with acute myocardial infarction? A thrombolytic era study

• Published in: European heart journal Vol. 20; no. 11; pp. 813 - 818
• Main Authors: Rotstein, Z., Mandelzweig, L., Lavi, B., Eldar, M., Gottlieb, S., Hod, H.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.06.1999
• Subjects: Acute myocardial infarction; Aged; Biological and medical sciences; Cardiology. Vascular system; coronary care unit; Coronary Care Units; Coronary heart disease; Female; Heart; Humans; Internal Medicine; Israel; Male; Medical sciences; Middle Aged; Multivariate Analysis; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Patients' Rooms; Prognosis; Risk Assessment; Survival Analysis; Thrombolytic Therapy; Tropical medicine; Israel; Human; Prognosis; Infarct; Internal medicine; Treatment efficiency; Mortality; Cardiovascular disease; Coronary heart disease; Myocardial disease; Morbidity; Intensive care unit; Treatment; Myocardium; Hospital ward; Medical specialty; Comparative study
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1053/euhj.1998.1452

Aims The purpose of our study was to examine and compare the prognosis of acute myocardial infarction patients hospitalized in an intensive coronary care unit and in an internal medicine ward, in the era of reperfusion therapy, and to identify factors associated with the observed outcomes. Methods and results Patients hospitalized for acute myocardial infarction during the period 1994–1997 at the Sheba Medical Center, Tel Hashomer, Israel (n=2114), were grouped according to the hospital department in which they were treated: the intensive coronary care unit (n=1443, 68·3%) or an internal medicine ward (n=671, 31·7%). Baseline characteristics, comorbidity, hospital course, use of procedures and 30-day mortality were compared between the groups. Stepwise logistic regression was used to identify the factors associated with 30-day mortality.Crude 30-day mortality rates were 5·4% among all patients hospitalized in the intensive coronary care unit compared with 15·9% for all patients in an internal medicine ward (P<0·001); in a subgroup of patients aged 70 years and above these rates were 11·0% and 21·0%, respectively (P<0·001). Among the independent predictors of the 30-day mortality identified in multivariate analysis was treatment only in an internal medicine ward (odds ratio: 1·48 ; 95% confidence interval: 1·00–2·18). Reperfusion therapy was independently associated with a 53% reduction in 30-day mortality. Conclusions Our findings emphasize the importance of the treatment of acute myocardial infarction in the setting of intensive coronary care units in the thrombolytic era, in order to ensure early access to advanced diagnostic and therapeutic options for all patients, including the elderly.