Related Experiment Videos
Major causes of death from acute myocardial infarction in a coronary care unit
1Department of Internal Medicine, National Cardiovascular Center, Osaka, Japan.
Insights
Aggressive treatments are needed for acute myocardial infarction patients who die from cardiogenic shock, reinfarction, or cardiac rupture. Conventional coronary care unit management is insufficient for these high-risk cases.
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- Acute myocardial infarction (AMI) management requires defining indications for novel aggressive therapies.
- Coronary care unit (CCU) outcomes analysis is crucial for identifying patient subgroups at high risk of mortality.
Purpose of the Study:
- To analyze therapeutic results in 1,060 AMI patients to define indications for new aggressive managements.
- To identify major causes of cardiac death in a CCU setting.
Main Methods:
- Retrospective analysis of 1,060 patients admitted to a CCU.
- Classification of deaths based on Killip's criteria and causes such as pump failure, cardiogenic shock, reinfarction, and cardiac rupture.
Main Results:
- Overall mortality was 14.9%, with 13.5% dying from cardiac complications.
- Killip class 4 patients had 86.6% mortality; cardiogenic shock caused 69 deaths.
- Free wall rupture/septal perforation and reinfarction/infarct extension caused 40.6% of cardiac deaths in lower Killip classes.
Conclusions:
- Major causes of CCU death include cardiogenic shock, reinfarction, and cardiac rupture.
- Conventional CCU management is inadequate for these high-risk patients.
- Emerging aggressive techniques like intracoronary thrombolysis and artificial hearts warrant investigation for indicated patients.
Abstract:
In order to define indications for newly developing aggressive managements for patients with acute myocardial infarction, an analysis of therapeutic results was made on 1,060 patients admitted to our coronary care unit (CCU). The total mortality was 14.9%, and 143 patients (13.5%) died from cardiac complications. These 143 patients were divided according to causes of death listed in Killip's classification. In the Killip class 4 group, mortality was as high as 86.6%, and all patients with previous infarction and/or hemodynamic abnormality of Forrester's subset 4 died. Pump failure caused death in 100 patients, of whom 69 were in a state of cardiogenic shock at the time of their admission. On the other hand, 58 patients, accounting for 40.6% of the cardiac deaths, were in Killip's class 1 or 2 at admission. In these 58 patients, 23 died from free wall rupture and/or perforation of the interventricular septum. Another 27 patients expired from reinfarction or infarct size extension and/or post-infarction angina. Thus, we can say that the major causes of death of patients in CCU are cardiogenic shock, reinfarction and cardiac rupture. We could not save these patients by using conventional CCU managements. Newly developing aggressive techniques, such as intracoronary thrombolysis and artificial hearts, seem to be indicated for these potentially fatal patients, while the effectiveness of these techniques should be verified as to such patients.