Step-down units are cost-effective alternatives to coronary care units with non-inferior outcomes in the management of ST-elevation myocardial infarction patients after successful primary percutaneous coronary intervention.
Yu-Shao ChouHsin-Yueh LinYi-Ming WengZhong Ning Leonard GohCheng-Yu ChienHsuan-Jui FanChih-Huang LiHsien-Yi ChenMing-Shun HsiehJoanna Chen-Yeen SeakChen-Ken SeakChen-June SeakPublished in: Internal and emergency medicine (2019)
Percutaneous coronary interventions (PCIs) within a door-to-balloon timing of 90 min have greatly decreased mortality and morbidity of ST-elevation myocardial infarction (STEMI) patients. Post-PCI, they are routinely transferred into the coronary care unit (CCU) regardless of the severity of their condition, resulting in frequent CCU overcrowding. This study assesses the feasibility of step-down units (SDUs) as an alternative to CCUs in the management of STEMI patients after successful PCI, to alleviate CCU overcrowding. Criteria of assessment include in-hospital complications, length of stay, cost-effectiveness, and patient outcomes up to a year after discharge from hospital. A retrospective case-control study was done using data of 294 adult STEMI patients admitted to the emergency departments of two training and research hospitals and successfully underwent primary PCI from 1 January 2014 to 31 December 2015. Patients were followed up for a year post-discharge. Student t test and χ2 test were done as univariate analysis to check for statistical significance of p < 0.05. Further regression analysis was done with respect to primary outcomes to adjust for major confounders. Patients managed in the SDU incurred significantly lower inpatient costs (p = 0.0003). No significant differences were found between the CCU and SDU patients in terms of patient characteristics, PCI characteristics, in-hospital complications, length of stay, and patient outcomes up to a year after discharge. The SDU is a viable cost-effective option for managing STEMI patients after successful primary PCI to avoid CCU overcrowding, with non-inferior patient outcomes as compared to the CCU.
Keyphrases
- percutaneous coronary intervention
- st elevation myocardial infarction
- end stage renal disease
- coronary artery disease
- newly diagnosed
- ejection fraction
- acute myocardial infarction
- acute coronary syndrome
- prognostic factors
- healthcare
- peritoneal dialysis
- emergency department
- palliative care
- coronary artery
- patient reported outcomes
- heart failure
- atrial fibrillation
- risk factors
- machine learning
- pain management
- metabolic syndrome
- chronic pain
- left ventricular
- electronic health record
- transcatheter aortic valve replacement