Patients with acute myocardial infarction who exhibit severe anterior infarction, left ventricular failure, sinus tachycardia, or ventricular arrhythmias remain at high risk for sudden death after CCU discharge and may require prolonged step-down monitoring.
Early risk factors associated with late sudden death post-CCU; leaves open whether extended monitoring improves outcomes in high-risk post-MI patients.
In a group of 339 patients with acute myocardial infarction treated in a coronary care unit, 273 left the unit while improving and were expected to leave hospital alive; 23 had a cardiac arrest or died suddenly while still in hospital-17 died immediately or after temporary resuscitation and six were resuscitated to leave hospital alive. Ventricular fibrillation was found in 13 of the 20 patients attended by the cardiac arrest team. The incidents were scattered from the 4th to the 24th day after the onset of infarction. Risk factors in these "late sudden death" patients were compared with the 250 patients who left the unit while improving and did not die or suffer cardiac arrest. The patients susceptible to late sudden death were characterized early in their hospital course by the findings of severe, predominantly anterior infarction, left ventricular failure, persistent sinus tachycardia, and frequent ventricular arrhythmias. It is suggested that such patients be chosen for prolonged observation in a second-stage coronary care unit.
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Thompson et al. (1971) studied this question.
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