Stable Patients With STEMI Rarely Require Intensive-Care-Level Therapy After Primary PCI

The disposition of patients presenting with ST-elevation myocardial infarction (STEMI) is commonly the coronary care unit. Recent studies have suggested that low-risk STEMI patients could be managed in a lower-acuity setting immediately after percutaneous coronary intervention (PCI). We sought to determine the frequency of downstream intensive-care therapy used in our "stable" STEMI patients post-PCI.

A single-centre, retrospective review was completed of consecutive patients who underwent primary PCI for STEMI between 2013 and 2016. Post-PCI, patients were defined as being stable if they had not required intensive-care therapy or suffered significant complications. Intensive-care therapies and complications were defined as invasive/noninvasive ventilation, pacing, cardiac arrest, use of vasopressors/inotropes, dialysis, stroke, or major bleeding. This group of stable patients had their course followed to discharge.

A total of 731 patients presented with STEMI for primary PCI. Of these, 132 patients (18%) required intensive-care therapies and/or had complications prior to PCI and were excluded. After PCI, 599 STEMI patients (82%) were defined as stable, according to the above definition. Of these, 11 patients (1.8%) required intensive-care therapies during their hospitalization. Zwolle scores were significantly higher in patients with complications (6.3 ± 4.4 vs 2.0 ± 1.5, P < 0.0001). The most frequent intensive-care complications and therapies were cardiac arrest (7 patients, 1%) and vasopressor use (4 patients, 0.7%). These complications most frequently occurred on the first admission day (6 patients, 1%).

Patients who are stable at the completion of their primary PCI rarely develop complications that require intensive care. These patients are easily identified for triage to a lower-acuity setting, alleviating congestion in cardiac care units and reducing hospitalization costs.