Caddell Andrew, Belliveau Daniel, Moeller Andrew, Quraishi Ata Ur Rehman
Cardiology Division, Dalhousie University, Halifax, Nova Scotia, Canada.
CJC Open. 2022 Jan 11;4(4):390-394. doi: 10.1016/j.cjco.2021.12.013. eCollection 2022 Apr.
The disposition of patients presenting with ST-elevation myocardial infarction (STEMI) is commonly the coronary care unit. Recent studies have suggested that low-risk STEMI patients could be managed in a lower-acuity setting immediately after percutaneous coronary intervention (PCI). We sought to determine the frequency of downstream intensive-care therapy used in our "stable" STEMI patients post-PCI.
A single-centre, retrospective review was completed of consecutive patients who underwent primary PCI for STEMI between 2013 and 2016. Post-PCI, patients were defined as being stable if they had not required intensive-care therapy or suffered significant complications. Intensive-care therapies and complications were defined as invasive/noninvasive ventilation, pacing, cardiac arrest, use of vasopressors/inotropes, dialysis, stroke, or major bleeding. This group of stable patients had their course followed to discharge.
A total of 731 patients presented with STEMI for primary PCI. Of these, 132 patients (18%) required intensive-care therapies and/or had complications prior to PCI and were excluded. After PCI, 599 STEMI patients (82%) were defined as stable, according to the above definition. Of these, 11 patients (1.8%) required intensive-care therapies during their hospitalization. Zwolle scores were significantly higher in patients with complications (6.3 ± 4.4 vs 2.0 ± 1.5, < 0.0001). The most frequent intensive-care complications and therapies were cardiac arrest (7 patients, 1%) and vasopressor use (4 patients, 0.7%). These complications most frequently occurred on the first admission day (6 patients, 1%).
Patients who are stable at the completion of their primary PCI rarely develop complications that require intensive care. These patients are easily identified for triage to a lower-acuity setting, alleviating congestion in cardiac care units and reducing hospitalization costs.
ST段抬高型心肌梗死（STEMI）患者通常会被安置在冠心病监护病房。近期研究表明，低风险STEMI患者在经皮冠状动脉介入治疗（PCI）后可在较低监护级别环境中进行管理。我们试图确定在我们“稳定”的STEMI患者PCI术后使用下游重症监护治疗的频率。
对2013年至2016年间因STEMI接受直接PCI的连续患者进行了单中心回顾性研究。PCI术后，如果患者不需要重症监护治疗或未发生严重并发症，则被定义为稳定。重症监护治疗和并发症定义为有创/无创通气、起搏、心脏骤停、使用血管加压药/正性肌力药、透析、中风或大出血。对这组稳定患者的病程进行随访直至出院。
共有731例患者因STEMI接受直接PCI。其中，132例患者（18%）在PCI前需要重症监护治疗和/或发生并发症，被排除在外。根据上述定义，PCI术后599例STEMI患者（82%）被定义为稳定。其中，11例患者（1.8%）在住院期间需要重症监护治疗。发生并发症的患者Zwolle评分显著更高（6.3±4.4对2. · 0±1.5，<0.0001）。最常见的重症监护并发症和治疗是心脏骤停（7例患者，1%）和使用血管加压药（4例患者，0.7%）。这些并发症最常发生在首次入院当天（6例患者，1%）。
直接PCI完成后病情稳定的患者很少发生需要重症监护的并发症。这些患者很容易被识别出来以便分流到较低监护级别环境，缓解心脏监护病房的拥堵并降低住院费用。
