The Course of Patients with Suspected Myocardial Infarction

The hospital course of all patients admitted to a medical intensive-care unit (ICU) with suspected myocardial infarction was reviewed to test the feasibility of identifying patients suitable for earlier transfer from the ICU. Three hundred sixty patients admitted after presentation with uncomplicated chest pain could be stratified into three risk groups within 24 hours of admission to the ICU. One hundred sixty-eight patients (47 per cent), who were without major complications, elevation of total serum creatine phosphokinase, or electrocardiographic evidence of transmural infarction during the first day, could be designated "low-risk" patients. Three per cent of the low-risk patients subsequently met clinical criteria for infarction, 2 percent had late complications in the ICU, and none died. Rates of infarction, late complications in the ICU, and mortality in the hospital were significantly higher for patients at intermediate and high risk. Identification of low-risk patients for whom early transfer may be routinely indicated is feasible and could reduce by 55 per cent the total number of days that such patients spend in the ICU.