Triage of low-risk post-PCI STEMI patients to a general telemetry unit resulted in a shorter average hospital length of stay (2.1 vs 3.3 days, P<.001) compared to CICU admission.
Cohort (n=547)
No
Does triage to a general telemetry unit based on a Zwolle score ≤3 safely reduce length of hospitalization compared to CICU admission in post-PCI STEMI patients?
Triage of low-risk STEMI patients (Zwolle score ≤3) to general telemetry after primary PCI is safe and significantly reduces hospital length of stay.
Absolute Event Rate: 2.1% vs 3.3%
p-value: p=<.001
ObjectiveTo analyze outcomes of patients with ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (PCI) triaged to the cardiac intensive care unit (CICU) vs a general telemetry unit by a Zwolle risk score–based algorithm.MethodsWe introduced a quality improvement protocol in 2014 encouraging admission of STEMI patients with Zwolle score of 3 or less to general telemetry units unless they were hemodynamically unstable. We subsequently conducted a retrospective single-center cohort study of consecutive STEMI patients who had undergone primary PCI from January 1, 2014, to December 31, 2018. Outcomes studied include immediate complications, need for urgent unplanned intervention, need for CICU care, length of hospitalization, and survival.ResultsWe identified 547 patients, 406 with a Zwolle score of 3 or less. Of these, 192 (47.3%) were admitted to general telemetry and 214 (52.7%) to the CICU. Reasons for CICU admission included persistent chest pain, late presentation, and procedural complications. The average hospital length of stay was 2.1±1.4 days for non-CICU patients and 3.3±2.8 days for low-risk CICU patients (P<.001). Two patients initially admitted to general telemetry required transfer to the CICU. There were 26 patients who required unplanned cardiovascular intervention within 30 days, 5 from the general telemetry unit; 540 patients survived to discharge. One in-hospital death occurred among those initially triaged to the general telemetry unit, and this was due to a noncardiac cause.ConclusionA Zwolle score–based algorithm can be used to safely triage post-PCI STEMI patients to a general telemetry unit.
Nan et al. (Fri,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=547). Triage to general telemetry unit vs. Cardiac intensive care unit (CICU) was evaluated on Hospital length of stay (p=<.001). Triage of low-risk post-PCI STEMI patients to a general telemetry unit resulted in a shorter average hospital length of stay (2.1 vs 3.3 days, P<.001) compared to CICU admission.