Apparently coronary heart disease-free patients in the coronary care unit: characteristics, medical care, and 1-year outcome.
BACKGROUND
Coronary care units (CCUs) have contributed significantly to the improved survival rates among patients with acute myocardial infarction. Many patients admitted to CCUs are certified to be free of coronary heart disease (CHD) at discharge. There is little literature on the hospital course and prognosis of such patients.


METHODS
We identified and followed 594 patients admitted to six CCUs in the Minneapolis-St Paul metropolitan area in 1990 because of suspected acute myocardial infarction who were eventually discharged without evidence of acute or chronic CHD. Their baseline characteristics, medical care, and 1-year outcome were compared with those of 672 patients with confirmed acute myocardial infarction and 612 patients with a history of CHD but without evidence of an acute coronary event.


RESULTS
Similar numbers of men and women were certified to be CHD-free on discharge from hospital. These patients were significantly younger than either patients with acute myocardial infarction or patients with a history of CHD (mean age 57, 65, and 67 years, respectively). CHD-free patients commonly reported current smoking, hypertension, and hypercholesterolemia (26, 50, and 18%, respectively). These patients were less likely than those with acute myocardial infarction or a history of CHD to undergo diagnostic or therapeutic procedures, or to receive pharmacological treatment. Their 1-year mortality rate was 5%, significantly lower (P < 0.05) than the mortality among patients with either acute myocardial infarction (18%) or a history of CHD (13%) but 2.6 times greater than expected in the general population. Older age, previous or current smoking, chest pain leading to admission, and congestive heart failure were independent predictors of 1-year mortality.


CONCLUSIONS
Patients certified to be CHD-free after admission to a CCU with suspected acute myocardial infarction have a lower 1-year mortality rate than patients experiencing acute myocardial infarction or chronic CHD. Their mortality rate, however, is substantially higher than expected, probably because of a high prevalence of cigarette smoking and hypertension.
Brodin
E C
EC
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015.
Shahar
E
E
Rosamond
W D
WD
McGovern
P G
PG
Sprafka
J M
JM
Doliszny
K M
KM
Luepker
R V
RV
D000368:Aged; D003325:Coronary Care Units; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D010351:Patient Discharge; D011379:Prognosis; D012307:Risk Factors; D012907:Smoking; D013997:Time Factors; D016896:Treatment Outcome