Do patients with ST segment elevation myocardial infarction in Killip class I need intensive cardiac care after a successful primary percutaneous intervention?
OBJECTIVE
There are limited data regarding the need for intensive care or the appropriate length of hospital stay for patients with ST elevation acute myocardial infarction (STEMI). In order to optimize resources, we tried to determine the need of coronary care unit (CCU) admission for patients with STEMI who remained in Killip class I after a successful primary percutaneous coronary intervention (PPCI).


METHODS
From August of 2006 till June of 2008, we analyzed data from all patients admitted in our CCU who met these criteria, a total of 278. We prospectively recorded all in-hospital adverse events and event-free survival at 30 and 90 days (all cause death, stroke, new acute coronary syndrome or re-hospitalization due to heart failure). Medical treatment was optimized according to the current guidelines.


RESULTS
A coronary stent was implanted in 96% of the patients. None of the patients had any adverse event that could not be resolved in a step-down unit. Survival at 30 and at 90 days was 99.6% and 98.3% respectively. Event-free survival was 97.3% at 30 days and 94.3% at 90 days. The median length of stay was three days in the CCU and five days in the hospital.


CONCLUSIONS
Patients with STEMI treated with PPCI who remained in Killip class I after the procedure and receive optimal pharmacological treatment have an excellent prognosis. All of them can probably be admitted safely to a step-down unit. Wide application of this management strategy may result in substantial cost savings.
Viana-Tejedor
Ana
A
Cardiology Department, La Paz University Hospital, Madrid, Spain. ana_viana_tejedor@hotmail.com
López De Sá
Esteban
E
Peña-Conde
Laura
L
Salinas-Sanguino
Pablo
P
Dobarro
David
D
Rey-Blas
Juan Ramón
JR
Armada-Romero
Eduardo
E
López-Sendón
José
J
D000359:Aftercare / Q000458:organization & administration; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D002423:Cause of Death; D003325:Coronary Care Units; D003422:Critical Care / Q000458:organization & administration; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000401:mortality / Q000628:therapy; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome