Key result
General ward admission was not associated with higher 30-day in-hospital mortality compared to the CCU for hemodynamically stable acute MI patients after primary PCI (HR 1.12; 95% CI 0.66-1.91).
Why the study?
Routine CCU admission for uncomplicated acute MI remains controversial despite guideline recommendations, prompting evaluation of the safety of general ward management in hemodynamically stable patients after primary PCI.
Does direct admission to the general ward increase 30-day in-hospital mortality compared to CCU admission in hemodynamically stable patients with acute MI after primary PCI?
Cohort (n=5,736)
Yes
Does direct admission to the general ward increase 30-day in-hospital mortality compared to CCU admission in hemodynamically stable patients with acute MI after primary PCI?
Direct admission to the general ward after primary PCI is feasible and not associated with increased 30-day in-hospital mortality in hemodynamically stable patients with acute MI.
Answers are grounded in this paper and cite their sources.
May support general ward care for stable post-PCI MI patients; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Although current guidelines recommend admission to the intensive/coronary care unit (ICU/CCU) for patients with ST-segment elevation myocardial infarction (MI), routine use of the CCU in uncomplicated patients with acute MI remains controversial. We aimed to evaluate the safety of management in the general ward (GW) of hemodynamically stable patients with acute MI after primary percutaneous coronary intervention (PCI). METHODS: Using a large nationwide administrative database, a cohort of 19426 patients diagnosed with acute MI in 52 hospitals where a CCU was available were retrospectively analyzed. Patients with mechanical cardiac support and Killip classification 4, and those without primary PCI on admission were excluded. A total of 5736 patients were included and divided into the CCU (n = 3488) and GW (n = 2248) groups according to the type of hospitalization room after primary PCI. Propensity score matching was performed, and 1644 pairs were matched. The primary endpoint was in-hospital mortality at 30 days. RESULTS: The CCU group had a higher rate of Killip classification 3 and ambulance use than the GW group. There was no significant difference in the incidence of in-hospital mortality within 30 days among the matched subjects. Multivariable Cox proportional hazard model analysis among unmatched patients supported the findings (hazard ratio 1.12, 95% confidence interval 0.66-1.91, p = 0.67). CONCLUSIONS: The use of the GW was not associated with higher in-hospital mortality in hemodynamically stable patients with acute MI after primary PCI. It may be feasible for the selected patients to be directly admitted to the GW after primary PCI.
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Tateishi et al. (2020) conducted a cohort in Acute myocardial infarction (n=5,736). General ward admission vs. Coronary care unit (CCU) admission was evaluated on In-hospital mortality at 30 days (HR 1.12, 95% CI 0.66-1.91, p=0.67). General ward admission was not associated with higher 30-day in-hospital mortality compared to the CCU for hemodynamically stable acute MI patients after primary PCI (HR 1.12; 95% CI 0.66-1.91).
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