Impact of High Care Unit Management on In-Hospital Mortality in Patients with ST-Elevation Myocardial Infarction

Area of Science:

• Cardiology
• Critical Care Medicine
• Health Services Research

Background:

• ST-elevation myocardial infarction (STEMI) is a critical condition requiring prompt intervention.
• The role of Heart Care Units (HCUs) in managing STEMI patients, particularly those with severe symptoms, needs further clarification.
• Primary percutaneous coronary intervention (PCI) is the standard treatment for STEMI.

Purpose of the Study:

• To evaluate the impact of Heart Care Unit (HCU) management on the short-term prognosis of STEMI patients undergoing primary PCI.
• To compare in-hospital mortality rates between STEMI patients admitted to hospitals with and without HCUs.

Main Methods:

• Retrospective analysis of 694 STEMI patients who underwent primary PCI between 2014-2018.
• Patients were categorized based on admission to hospitals with (n=353) or without (n=341) HCUs.
• Propensity score matching was used to control for confounding variables.

Main Results:

• No significant difference in overall in-hospital mortality between HCU and non-HCU groups initially.
• In-hospital mortality was significantly lower in the HCU group for patients with Killip Class II or higher (20% vs. 44%, P < 0.001).
• After propensity score matching, overall in-hospital mortality was significantly lower in the HCU group (2% vs. 8%, P = 0.008).
• Mortality rates for patients requiring mechanical ventilation or circulatory support were lower in the HCU group (30% vs. 50%, P = 0.037).

Conclusions:

• Systemic management in Heart Care Units (HCUs) significantly improves survival prognosis for STEMI patients with Killip classification of II or higher.
• HCUs are particularly beneficial in hospitals without Cardiac Care Units (CCUs) for managing high-risk STEMI patients.
• The findings support the integration of HCU management to enhance outcomes for severe STEMI cases.