Division of Cardiology, University of Alberta, Canada.
Canadian Vigour Center, University of Alberta, Canada.
Eur Heart J Acute Cardiovasc Care. 2020 Dec;9(8):923-930. doi: 10.1177/2048872619883400. Epub 2019 Oct 30.
Emerging evidence suggests that coronary intensive care units are evolving into intensive care environments with an increasing burden of non-cardiovascular illness, but previous studies have been limited to older populations or single center experiences.
Canadian national health-care data was used to identify all patients ≥18 years admitted to dedicated coronary intensive care units (2005-2015) and admissions were categorized as primary cardiac or non-cardiac. The outcomes of interest included longitudinal trends in admission diagnoses, critical care therapies, and all-cause in-hospital mortality.
Among the 373,992 patients admitted to a coronary intensive care unit, minimal changes in the proportion of patients admitted with a primary cardiac (88.2% to 86.9%; <0.001) and non-cardiac diagnoses (11.8% to 13.1%; <0.001) were observed. Among cardiac admissions, a temporal increase in the proportion of ST-segment elevation myocardial infarction (19.4% to 24.1%, <0.001), non-ST-segment elevation myocardial infarction (14.6% to 16.2%, <0.001), heart failure (7.3% to 8.4%, <0.001), shock (4.9% to 5.7%, <0.001), and decline in unstable angina (4.9% to 4.0%, <0.001) and stable coronary diseases (21.3% to 12.4%, <0.001) was observed. The proportion of patients requiring critical care therapies (57.8% to 63.5%, <0.001) including mechanical ventilation (9.6% to 13.1%, <0.001) increased. In-hospital mortality rates for patients with primary cardiac (4.9% to 4.4%; adjusted odds ratio 0.71, 95% confidence interval 0.63-0.79) and non-cardiac (17.8% to 16.1%; adjusted odds ratio 0.84, 0.73-0.97) declined; results were consistent when stratified by academic vs community hospital, and by the presence of on-site percutaneous coronary intervention.
In a national dataset we observed a changing case-mix among patients admitted to a coronary intensive care unit, though the proportion of patients with a primary cardiac diagnosis remained stable. There was an increase in clinical acuity highlighted by critical care therapies, but in-hospital mortality rates for both primary cardiac and non-cardiac conditions declined across all hospitals. Our findings confirm the changing coronary intensive care unit case-mix and have implications for future coronary intensive care unit training and staffing.
新出现的证据表明，冠状动脉重症监护病房正在演变为重症监护环境，其中非心血管疾病的负担不断增加，但以前的研究仅限于老年人群或单中心经验。
利用加拿大国家卫生保健数据，确定所有≥18 岁的患者，这些患者被收治于专门的冠状动脉重症监护病房（2005-2015 年），并将其入院诊断分为主要心脏或非心脏。研究的结果包括入院诊断、重症监护治疗和全因院内死亡率的纵向趋势。
在 373992 名被收治于冠状动脉重症监护病房的患者中，主要心脏（88.2%降至 86.9%；<0.001）和非心脏诊断（11.8%升至 13.1%；<0.001）的患者比例变化不大。在心脏入院患者中，ST 段抬高型心肌梗死（19.4%升至 24.1%；<0.001）、非 ST 段抬高型心肌梗死（14.6%升至 16.2%；<0.001）、心力衰竭（7.3%升至 8.4%；<0.001）、休克（4.9%升至 5.7%；<0.001）以及不稳定型心绞痛（4.9%降至 4.0%；<0.001）和稳定型冠心病（21.3%降至 12.4%；<0.001）的比例有所增加。需要重症监护治疗（57.8%升至 63.5%；<0.001）的患者比例增加，包括机械通气（9.6%升至 13.1%；<0.001）。主要心脏（4.9%降至 4.4%；调整后的优势比 0.71，95%置信区间 0.63-0.79）和非心脏（17.8%降至 16.1%；调整后的优势比 0.84，0.73-0.97）患者的院内死亡率下降；当按学术与社区医院、是否有现场经皮冠状动脉介入治疗进行分层时，结果一致。
在国家数据集的观察中，我们发现被收治于冠状动脉重症监护病房的患者的病例组合发生了变化，尽管主要心脏诊断的患者比例保持稳定。临床严重程度增加，这突出表现在重症监护治疗方面，但所有医院的主要心脏和非心脏疾病的院内死亡率均有所下降。我们的发现证实了冠状动脉重症监护病房病例组合的变化，并对未来的冠状动脉重症监护病房培训和人员配置产生影响。
