Site of care and survival after acute myocardial infarction

The effect of admission of different types of unit (coronary care, mixed intensive care, medical ward) on survival after documented acute myocardial infarction was examined in nine public hospitals in Queensland. Australia Among 466 subjects, the over-all crude case fatality rate (CFR) was 20.0%. The CFR, after admission to a coronary care unit (CCU), was 18.3%, to an intensive care unit (ICU), 16.1%, and to wards, 25.3%. Adjustment by a multivariate prognostic score gave standardized CFRs of 19.4% (CCU), 16.3% (ICU) and 23.8% (ward). The relative risk of dying (with 95% confidence limits) for CCU/ICU admissions combined, compared with ward admissions, was 0.67 (0.47 to 0.97) (crude), and 0.78 (0.61 to 1.00) (adjusted for prognostic score). The lowered mortality rates among infarct patients who received special care were most marked among those under 60 years of age. These data indicate that subjects who received special care had an increased survival period after myocardial infarction compared with those admitted to medical wards. However, this study provides no support for establishing a CCU in those provincial hospitals which have an adequate number of ICU beds available for the treatment of myocardial infarction.