Unexpected readmissions to the coronary-care unit during recovery from acute myocardial infarction

Because it is difficult to predict the course in a patient recovering from acute myocardial infarction who is stable enough to leave the coronary-care unit (CCU), we studied such patients in order to identify those at risk of complications. Over two years of study, 485 of 536 consecutive patients admitted with myocardial infarction survived their first stay in the CCU. Complications serious enough to warrant readmission developed in 61 (13%). Readmissions occurred early: half were within 2.7 days of initial transfer from the unit. The subsequent course was severely complicated: 16 readmitted patients (26%) died in the hospital. Physicians were not able to identify clearly these high-risk patients during their first stay in the CCU. Several previously cited indicators of poor prognosis did not help identify those later readmitted, but recurrent ischemic pain that occurred for the first time after 24 hours in the CCU did. The absence of rales on admission, coupled with absence of recurrent chest pain, was indicative of a subgroup with a favorable short-term prognosis.