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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Do patients with ST segment elevation myocardial infarction in Killip class I need intensive cardiac care after a
Ana Viana-Tejedor1, Esteban López De Sá, Laura Peña-Conde
1Cardiology Department, La Paz University Hospital, Madrid, Spain. ana_viana_tejedor@hotmail.com
Insights
Patients with ST elevation acute myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) who remain in Killip class I can likely be safely admitted to a step-down unit, optimizing resource use.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Health Resource Management
Background:
- Limited data exist on intensive care needs and hospital stay duration for ST elevation acute myocardial infarction (STEMI) patients.
- Optimizing healthcare resource allocation is crucial for managing STEMI patients.
Purpose of the Study:
- To determine the necessity of Coronary Care Unit (CCU) admission for STEMI patients who are Killip class I post-primary percutaneous coronary intervention (PPCI).
- To evaluate the safety and efficacy of admitting these patients to a step-down unit.
Main Methods:
- Analysis of 278 STEMI patients admitted to CCU between August 2006 and June 2008.
- Prospective recording of in-hospital adverse events and 30/90-day event-free survival (death, stroke, new ACS, heart failure re-hospitalization).
- Standardized medical treatment according to current guidelines.
Main Results:
- 96% of patients received coronary stents.
- No adverse events occurred that necessitated CCU-level care.
- 30-day and 90-day survival rates were 99.6% and 98.3%, respectively.
- 30-day and 90-day event-free survival rates were 97.3% and 94.3%, respectively.
- Median CCU and hospital stays were 3 and 5 days, respectively.
Conclusions:
- STEMI patients treated with PPCI, remaining Killip class I, and receiving optimal medical therapy exhibit excellent prognosis.
- These patients can likely be safely managed in a step-down unit.
- Implementing this strategy could lead to significant cost savings.
Background And Objective:
There are limited data regarding the need for intensive care or the appropriate length of hospital stay for patients with ST elevation acute myocardial infarction (STEMI). In order to optimize resources, we tried to determine the need of coronary care unit (CCU) admission for patients with STEMI who remained in Killip class I after a successful primary percutaneous coronary intervention (PPCI).
Methods:
From August of 2006 till June of 2008, we analyzed data from all patients admitted in our CCU who met these criteria, a total of 278. We prospectively recorded all in-hospital adverse events and event-free survival at 30 and 90 days (all cause death, stroke, new acute coronary syndrome or re-hospitalization due to heart failure). Medical treatment was optimized according to the current guidelines.
Results:
A coronary stent was implanted in 96% of the patients. None of the patients had any adverse event that could not be resolved in a step-down unit. Survival at 30 and at 90 days was 99.6% and 98.3% respectively. Event-free survival was 97.3% at 30 days and 94.3% at 90 days. The median length of stay was three days in the CCU and five days in the hospital.
Conclusion:
Patients with STEMI treated with PPCI who remained in Killip class I after the procedure and receive optimal pharmacological treatment have an excellent prognosis. All of them can probably be admitted safely to a step-down unit. Wide application of this management strategy may result in substantial cost savings.
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