Updated management of non-st-segment elevation acute coronary syndromes: selection of patients for low-cost care: an analysis of outcome and cost effectiveness.
BACKGROUND
The management of patients with acute coronary syndromes without ST-segment elevation (NSTEACS) in a chest pain unit (CPU) should represent a cost-effective advantage over conventional management in a coronary care unit (CCU). However, the safety and advantages of this approach are still unresolved.


METHODS
Outcomes and management costs were evaluated in patients with NSTEACS with intermediate-high TIMI risk scores (> or =3) randomized to receive management in a CPU or a CCU. Coronary events (CEs: angina, myocardial infarction, and death), revascularization, and resource utilization were compared between the two groups during hospital stay and at 6 months.


RESULTS
Two hundred and ten patients were enrolled, 104 in the CPU and 106 in the CCU group. CEs were similar in both groups both during hospitalization (28% vs. 26%, respectively) and at 6 months (17% vs. 16%). Angiography was performed in 67% vs. 75%; CPU patients less frequently underwent revascularization (53% vs. 76%; p=0.002). In-hospital duration was similar in both groups (7.5 days vs. 5.7 days). CPU patients had a 22% reduction in overall hospitalization costs compared with conventional management (9,913 vs. 12,056 euros/patient; p=0.01). This gain was particularly relevant (29%) when patients with TIMI risk score < or =4 were considered (10,599 vs. 13,699 euros/patient; p=0.004).


CONCLUSIONS
CPU care of NSTEACS is a safe and cost-effective alternative to conventional CCU management, particularly appealing with regard to patients presenting with intermediate TIMI risk score (< or =4) in whom CPU management could optimize the use of cath-lab facilities and dedicated cardiologists.
Conti
Alberto
A
Careggi General Hospital, Florence, Italy. aaaconti@hotmail.com
Pieralli
Filippo
F
Sammicheli
Lucia
L
Camaiti
Alberto
A
Vanni
Simone
S
Grifoni
Stefano
S
Dovellini
Emilio
E
Antoniucci
David
D
Squillantini
Giovanni
G
Mazzuoli
Francesco
F
Colombo
Giorgio
G
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D003365:Costs and Cost Analysis / Q000191:economics; D004452:Echocardiography; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome