Major causes of death from acute myocardial infarction in a coronary care unit.

In order to define indications for newly developing aggressive managements for patients with acute myocardial infarction, an analysis of therapeutic results was made on 1,060 patients admitted to our coronary care unit (CCU). The total mortality was 14.9%, and 143 patients (13.5%) died from cardiac complications. These 143 patients were divided according to causes of death listed in Killip's classification. In the Killip class 4 group, mortality was as high as 86.6%, and all patients with previous infarction and/or hemodynamic abnormality of Forrester's subset 4 died. Pump failure caused death in 100 patients, of whom 69 were in a state of cardiogenic shock at the time of their admission. On the other hand, 58 patients, accounting for 40.6% of the cardiac deaths, were in Killip's class 1 or 2 at admission. In these 58 patients, 23 died from free wall rupture and/or perforation of the interventricular septum. Another 27 patients expired from reinfarction or infarct size extension and/or post-infarction angina. Thus, we can say that the major causes of death of patients in CCU are cardiogenic shock, reinfarction and cardiac rupture. We could not save these patients by using conventional CCU managements. Newly developing aggressive techniques, such as intracoronary thrombolysis and artificial hearts, seem to be indicated for these potentially fatal patients, while the effectiveness of these techniques should be verified as to such patients.