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[Mortality in 709 patients with acute myocardial infarct treated in the intensive care unit]
P Eichhorn1, A Vuilliomenet, P Levis
1Medizinische Klinik, Stadtspital Triemli, Zürich.
Insights
Cardiogenic shock is the leading cause of early death in acute myocardial infarction patients. Early intervention, especially for those under 70, and improved pre-hospital care are crucial for reducing mortality.
Area of Science:
- Cardiology
- Critical Care Medicine
Context:
- Analysis of 709 patients admitted to a coronary care unit for acute myocardial infarction over 36 months.
- Early mortality rate in the coronary care unit was 10.9% (77 deaths).
Purpose:
- To assess the quality of care for acute myocardial infarction (AMI) patients.
- To identify potential for early intervention in reducing mortality.
Summary:
- Cardiogenic shock accounted for 73% of early deaths.
- Younger patients (<70 years) dying from cardiogenic shock represent a key group for intervention.
- Retrospective analysis identified potential improvements in pre-hospital management for some patients.
Impact:
- Highlights cardiogenic shock as the primary driver of early AMI mortality.
- Suggests that enhanced pre-infarction risk identification and reduced pre-hospital delays are essential for further mortality reduction.
Abstract:
To control the quality of our care and to define the potential for lifesaving early intervention in patients with acute myocardial infarction, we analyzed the course of 709 patients (66.4 +/- 10.8 yrs) admitted to the coronary care unit for acute myocardial infarction over a period of 36 months. 77 patients (70.2 +/- 9.3 yrs) died in the coronary care unit, and thus early mortality was 10.9%. Only 8% died from disturbances of cardiac rhythm and 19% from rupture of a ventricle. 73% died in cardiogenic shock, of whom 21 were below 70 years old and represent a potential group for early intervention. In 13 patients of this subgroup possibilities of better management in the pre-hospital phase were found retrospectively. In 5/77 patients the optimal treatment was not achieved during clinical course. Cardiogenic shock is the major cause of death in the early phase of acute myocardial infarction. A further substantial reduction of mortality will be achieved only by reaching more risk patients in the pre-infarction phase and by shortening the pre-hospital phase.