Intermediate coronary care. Observations on the validity of the concept

Recognition of significant mortality among hospitalized patients with myocardial infarction after dismissal from the coronary care unit (CCU) has led to the introduction of the intermediate coronary care unit (ICCU). It had been hoped that protracted monitoring during the convalescent phase of acute myocardial infarction might prevent sudden death, as in the CCU. Study of patterns of survival among 1,361 patients with acute myocardial infarction included 814 patients treated prior to the establishment of an ICCU and 557 managed in such a unit. Analysis of the two groups (including such high-risk factors as congestive heart failure, tachyarrhythmias, previous infarction, cardiac enlargement, and other unfavorable manifestations) failed to reveal a reduction in mortality after introduction of the ICCU. Thus, the value of the ICCU cannot be demonstrated in terms of mortality. Other benefits of the ICCU are projected, which include more sophisticated evaluation of the patient prior to discharge from the hospital and expanded opportunities for education of patients. A definite role of the ICCU in the total management of the patient with coronary arterial disease is postulated.