Continuing evaluation of coronary care.

Continuing evaluation of coronary care is necessary to determine its present effectiveness and to establish direction in the effort to decrease mortality after myocardial infarction. Data have been collected on 157 consecutive patients diagnosed as having myocardial infarction who were admitted to the coronary-care unit at St. Joseph's Hospital and Medical Center, Phoenix, Ariz. The hospital is a teaching hospital with a 560-bed capacity. Data sheets were completed on each patient at the time of transfer from the coronary-care unit. The accumulated data were processed by a computer at the end of a 13-month period. The overall mortality for the group was 16.5 per cent. The factors which were found to have a significant effect on mortality were: (1) location of infarction, (2) presence of heart failure, (3) occurrence of cardiogenic shock, (4) age, and (5) the presence of intraventricular conduction defect. In 19 of the 26 deaths after myocardial infarction, the terminal event was associated with congestive heart failure, pulmonary edema, or cardiogenic shock. Three patients died of resistant arrhythmia, four of ventricular rupture. These figures indicate that arrhythmia is not a primary cause of death after myocardial infarction and that attention must also be directed to the early diagnosis and treatment of left ventricular failure if coronary care survival rates are to improve.