Risk-Based Triage Strategies May Optimize Post-STEMI ICU Utilization

Most patients with STEMI are treated in the ICU.

HealthDay News — Most patients with ST-segment elevation myocardial infarction (STEMI) are treated in the intensive care unit (ICU), according to a study published in the April 22 issue of JACC: Cardiovascular Interventions.

Jay S. Shavadia, M.D., from the Duke Clinical Institute in Durham, North Carolina, and colleagues examined patterns of ICU utilization among 19,507 hemodynamically stable patients with STEMI (age, ≥65 years) treated with uncomplicated primary percutaneous coronary intervention (PCI). Baseline patient characteristics, laboratory results, and hospital characteristics were stratified by timing of reperfusion (early, intermediate, or late).

The researchers found that 82.3 percent of the patients were treated in ICUs, with a median ICU stay of one day. The median time from first medical contact (FMC) to device was 79 minutes: 22.0, 44.8, and 33.2 percent of patients had early, intermediate, and late reperfusion, respectively. There was no difference noted in ICU utilization rates for patients with early, intermediate, and late reperfusion times (82, 83, and 82 percent, respectively; P for trend = 0.44). While hospitalized, 16.2 percent of patients developed complications requiring ICU care; the likelihood of developing at least one of these complications was increased with longer FMC-to-device times (early, 13.4 percent; intermediate, 15.7 percent; and late, 18.7 percent; P for trend < 0.001; adjusted odds ratio for intermediate and late versus early: 1.13 and 1.22, respectively).

“Improved prediction aimed at the timely identification of patients at greatest risk for developing complications could help in safely rationalizing ICU triage decisions for patients with STEMI,” the authors write.

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