Suspect myocardial infarction: hospital management and prognosis

The management of 442 consecutive patients admitted for suspect acute myocardial infarction (?MI) was compared at two urban hospitals. The community hospital utilized an unmonitored observation unit (OU) more frequently than did the university hospital (39% vs. 9%, respectively). Progression to acute myocardial infarction (AMI) occurred in 25% of admissions, 5-7% of whom died. Mortality without AMI was rare. Availability of the OU appeared to result in reduced coronary care unit (CCU) utilization and in shorter hospital stays for low-risk patients who comprised fully 37% of hospital admissions. Low- and high-risk subgroups (12% vs. 34% risk of AMI) were identified by normal versus abnormal admission electrocardiograms (EKG). Two-thirds of the low-risk patients with AMI were diagnosed by the next hospital day. A normal EKG on both the day of admission and on the second hospital day identified a population with less than 1% risk of in-hospital AMI. The increased use of non-CCU facilities for many ?MI patients appears to be appropriate. However, only randomized allocation trials, which were never performed for patients with definite AMI, would establish the relative efficacy of CCU versus non-CCU treatment.