Specialized CCUs reduced 30-day cardiovascular mortality in STEMI patients post-pPCI with HR 2.127 for higher mortality in general wards and improved management efficiency.
Does admission to specialized cardiac care units compared to general medical wards improve clinical outcomes and management efficiency in patients undergoing pPCI for acute coronary syndrome?
Admission to specialized cardiac care units after pPCI for ACS improves management efficiency and reduces 30-day cardiovascular mortality specifically in STEMI patients compared to general medical wards.
Absolute Event Rate: 0% vs 0%
Abstract Background Current 2023 ESC Guidelines for the management of acute coronary syndromes (ACS) 1 recommend admitting high-risk patients to specialized cardiac care units (CCUs) with comprehensive monitoring facilities after primary percutaneous coronary intervention (pPCI) to enable early detection of complications. However, this recommendation is based on expert consensus rather than robust scientific evidence. Purpose This study aims to evaluate cardiovascular outcomes and management efficiency of ACS patients treated in CCUs versus general medical wards. Methods 4,600 patients undergoing pPCI for ACS at a tertiary cardiac catheterization centre between 2010 and 2021 were enrolled and followed for a total of 26,566 patient-years. The primary study outcome was defined as clinical net benefit reflected by mortality and classical 3-point MACE (composite of cardiovascular mortality, non-fatal myocardial infarction, stroke or transitory ischemic attacks). Secondary outcomes focused on the efficiency of in-hospital management. Results In the total study cohort (median age 61 52-71 years; BMI 27.1 24.6-30.5 kg/m², 75% male), 3,073 (66.8%) patients were admitted to CCUs and 1,527 (33.2%) to general medical wards after pPCI. While more STEMIs (64.7% vs. 58.9%; p 0.001) with higher SYNTAX scores (9 6-17 vs. 9 5-15; p 0.001) were treated at CCUs, patients on general medical wards were older (60 52-71 vs. 62 53-73 years; p 0. 001) and presented with more comorbidities such as vascular disease and chronic kidney disease. Both cohorts had comparable duration of intervention, number of vessels treated and LMCA stenosis. Through the total follow-up period, 20.2% of all patients died from any causes, 9.0% from cardiovascular reasons, and 32.8% experienced MACE. Cox regression analysis adjusted for demographic and clinical parameters showed no significant association of the primarily treating department and clinical outcomes in the total study population. However, subgroup analysis revealed increased 30-day cardiovascular mortality for STEMI patients in general medical wards (adj. HR 2.127 95% CI 1.099-4.116; p = 0.025). In addition, in-hospital management showed longer hospital stays (6 4-9 days vs. 7 5-11 days; p 0.001) and increased delays to post-interventional procedures (e.g. time to echocardiography, 3 1-4 days vs. 3 2-5 days; p 0.001) for patients in general medical wards. These delays were primarily observed in the NSTE-ACS subgroup. Conclusions Specialized CCUs improve management efficiency and short-term outcomes in ACS patients after pPCI, particularly for STEMI patients, who show significantly lower 30-day cardiovascular mortality compared to patients treated in general medical wards. These findings strongly support the 2023 ESC recommendations for admitting high-risk ACS patients to specialized units after pPCI and underscore the importance of CCUs in optimizing post-interventional care.
Steinacher et al. (Sat,) reported a other. Specialized CCUs reduced 30-day cardiovascular mortality in STEMI patients post-pPCI with HR 2.127 for higher mortality in general wards and improved management efficiency.