Safety and Cost Implications of General Ward versus Coronary Care Unit Admission After PCI for Stable STEMI: A
Haiqin Xu1, Liangqing Ge2, Zhixiang Zhang2
1Department of Cardiac Electrophysiology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), Changde, People's Republic of China.
Insights
Triage of stable ST-segment elevation myocardial infarction (STEMI) patients to general wards after percutaneous coronary intervention (PCI) significantly reduces hospital costs. This approach is safe, showing no significant increase in major adverse cardiovascular events (MACE) compared to coronary care unit admission.
Area of Science:
- Cardiology
- Health Economics
- Healthcare Management
Background:
- COVID-19 pandemic necessitated changes in coronary care unit (CCU) admission protocols.
- Infection control measures required risk assessment for patient triaging.
- Evaluating general ward admission for stable ST-segment elevation myocardial infarction (STEMI) patients post-percutaneous coronary intervention (PCI) was crucial.
Purpose of the Study:
- To assess the safety and cost-effectiveness of triaging clinically stable STEMI patients (P-STEMI) to general wards versus CCU.
- To compare total hospitalization costs, major adverse cardiovascular events (MACE), and length of stay (LOS) between the two groups.
Main Methods:
- Retrospective analysis of 486 P-STEMI patients undergoing PCI (January 2020 - December 2022).
- Patients were triaged to general wards (82) or CCU (404) based on a protocol including COVID-19 status and clinical stability.
- Propensity score matching (1:1) was used to balance covariates for comparison.
Main Results:
- General ward admission was associated with significantly lower total hospitalization costs in both the original cohort and after propensity score matching (PSM).
- While the original cohort showed lower MACE in the general ward group, this difference was not statistically significant after PSM.
- No significant difference in length of stay (LOS) was observed between the groups.
Conclusions:
- Triage to general wards for stable P-STEMI patients post-PCI is a safe strategy.
- This approach leads to significantly reduced hospitalization costs without compromising patient safety regarding MACE.
- The findings support the potential for optimizing resource allocation in cardiac care.
Background:
Routine coronary care unit (CCU) admission after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) was affected during the COVID-19 pandemic. Infection control requirements require clinical assessment-based triaging to identify low-risk patients suitable for general ward admission. This study evaluated whether triaging clinically stable patients with STEMI (P-STEMI) to general wards is safe and cost-effective compared with CCU admission.
Methods:
This single-centre retrospective study included 486 P-STEMI who underwent PCI between January 2020 and December 2022; 82 were triaged to general wards and 404 to the CCU. A triage protocol based on COVID-19 testing status and clinical stability was implemented. Covariates were preselected using a directed acyclic graph (DAG) and balanced between groups via 1:1 propensity score matching. The primary outcome was total hospitalisation costs; secondary outcomes included in-hospital major adverse cardiovascular events (MACE) and length of stay.
Results:
In the original cohort, the general ward group had significantly lower costs (median $3515.59 vs $4057.86, p<0.001) and MACE rates (2.44% vs 16.83%; p<0.001). After PSM (76 patients each), general ward admission remained significantly associated with reduced hospitalisation costs (median $3515.15 vs $3798.86, p=0.049). However, the difference in MACE was no longer significant (2.63% vs 3.95%, p=0.649). No significant difference in LOS was observed. The Zwolle risk score demonstrated good predictive ability for in-hospital MACE (AUC=0.867).
Conclusion:
For clinically stable P-STEMI post-PCI, triage to general wards was associated with significantly lower hospitalisation costs, and no statistically significant difference in MACE was observed.
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