Does the coronary care unit improve prognosis of patients with acute myocardial infarction? A thrombolytic era study

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Abstract
Aims The purpose of our study was to examine and compare the prognosis of acute myocardial infarction patients hospitalized in an intensive coronary care unit and in an internal medicine ward, in the era of reperfusion therapy, and to identify factors associated with the observed outcomes. Methods and results Patients hospitalized for acute myocardial infarction during the period 1994–1997 at the Sheba Medical Center, Tel Hashomer, Israel (n=2114), were grouped according to the hospital department in which they were treated: the intensive coronary care unit (n=1443, 68·3%) or an internal medicine ward (n=671, 31·7%). Baseline characteristics, comorbidity, hospital course, use of procedures and 30-day mortality were compared between the groups. Stepwise logistic regression was used to identify the factors associated with 30-day mortality.Crude 30-day mortality rates were 5·4% among all patients hospitalized in the intensive coronary care unit compared with 15·9% for all patients in an internal medicine ward (PPConclusions Our findings emphasize the importance of the treatment of acute myocardial infarction in the setting of intensive coronary care units in the thrombolytic era, in order to ensure early access to advanced diagnostic and therapeutic options for all patients, including the elderly.

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