Outcomes in patients with myocardial infarction who are initially admitted to stepdown units: data from the
N H Fiebach1, E F Cook, T H Lee
1Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Insights
Admitting chest pain patients with a low risk of myocardial infarction to a stepdown unit is safe. Outcomes for patients who did have a myocardial infarction were similar regardless of initial unit assignment.
Area of Science:
- Cardiology
- Clinical Medicine
- Patient Triage
Background:
- Chest pain is a common presentation in emergency departments.
- Accurate risk stratification is crucial for appropriate patient management.
- Myocardial infarction (MI) requires prompt and specialized care.
Purpose of the Study:
- To evaluate if admitting chest pain patients to a stepdown unit impacts outcomes for those diagnosed with myocardial infarction.
- To compare the safety of stepdown unit vs. coronary care unit admission for rule-out MI patients.
Main Methods:
- Retrospective comparison of "rule-out MI" patients admitted to stepdown units versus coronary care units.
- Inclusion of initially uncomplicated patients across six hospitals.
- Analysis of adverse outcomes including death, complications, and interventions.
Main Results:
- Adverse outcomes occurred in 28% of stepdown unit patients vs. 39% of coronary care unit patients.
- Multivariate analysis showed similar risks of adverse outcomes between the two groups after controlling for clinical factors.
Conclusions:
- Initial triage to a stepdown unit does not appear to jeopardize patients who are ultimately diagnosed with myocardial infarction.
- Further larger studies are warranted to confirm these findings and explore potential benefits of stepdown unit care.
Purpose:
To assess whether the admission of patients with chest pain to a stepdown unit would jeopardize the outcome of those patients who ultimately "ruled in" for a myocardial infarction.
Patients And Methods:
We compared the risk of an adverse outcome in initially uncomplicated, "rule-out myocardial infarction" patients who were admitted directly to a stepdown unit (n = 58) or to a coronary care unit (n = 409) at 6 hospitals and who then ultimately "ruled in" for a myocardial infarction.
Results:
An adverse outcome (death, serious complication, or invasive intervention) occurred in 16 (28%) stepdown unit patients compared with 159 (39%) coronary care unit patients. Among patients eligible for initial care in either location, the risk of an adverse outcome after controlling for clinical characteristics was similar in the two groups using each of two different multivariate approaches.
Conclusion:
Although our study was not of sufficient size to exclude the possibility of a small benefit from initial triage to a coronary care unit, our data suggest that (1) admission of initially uncomplicated chest pain patients with a relatively low probability of acute myocardial infarction to a stepdown unit does not seriously jeopardize those who eventually "rule in" for myocardial infarction; and (2) larger observational or randomized studies, which could reduce the residual possibility of somewhat higher risk in the stepdown unit, would be ethical to perform.
More Related Videos
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:20Angina V: Nursing Management