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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study
Thomas S Valley1,2,3, Theodore J Iwashyna1,2,4, Colin R Cooke1,2,5
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Insights
Intensive care unit (ICU) admission for ST-elevation myocardial infarction (STEMI) patients is linked to reduced 30-day mortality. Further research is needed to pinpoint which STEMI patients benefit most from ICU care.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring prompt and intensive management.
- The role of intensive care unit (ICU) admission in STEMI patient outcomes remains an area of investigation.
- Understanding the impact of ICU care on mortality is crucial for optimizing treatment strategies.
Purpose of the Study:
- To evaluate the effect of intensive care unit (ICU) admission on 30-day mortality in patients with ST-elevation myocardial infarction (STEMI).
- To compare mortality rates between STEMI patients admitted to ICUs versus non-ICU units.
Main Methods:
- Retrospective cohort study involving 109,375 Medicare beneficiaries (aged 65+) admitted with STEMI across 1727 US hospitals (2014-2015).
- Instrumental variable analysis used hospital ICU admission rates for STEMI as an instrument to address confounding.
- Primary outcome was 30-day mortality. A secondary analysis examined non-STEMI patients.
Main Results:
- ICU admission for STEMI patients was associated with a 6.1 percentage point decrease in 30-day mortality compared to non-ICU admission.
- In contrast, for non-STEMI patients, ICU admission showed no significant difference in mortality.
- Hospitals with higher ICU admission rates (top quartile) admitted 85% or more of their STEMI patients to the ICU.
Conclusions:
- Intensive care unit (ICU) care for ST-elevation myocardial infarction (STEMI) is associated with improved survival.
- There is a need to identify specific STEMI patient subgroups that benefit from ICU admission and the specific components of ICU care that are most effective.
Objective:
To evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).
Design:
Retrospective cohort study.
Setting:
1727 acute care hospitals in the United States.
Participants:
Medicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015.
Main Outcome Measure:
30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI.
Results:
The analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval -11.9 to -0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (-0.9 to 3.4) percentage points).
Conclusions:
ICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.
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