Acute myocardial infarction: coronary care unit, hospital ward or home management?

The need of admission of all patients with acute myocardial infarction in a CCU is questioned by some british authors. A critical review of their publications stresses the most important methodological problems they could not overcome; consequently they cannot allow any valuable comparison. There are no randomized trial related to the comparison of general ward to CCU care, but the available data obtained by studies based on bed availability show a definite advantage of the CCU. At the present stage of our knowledge, admission in a CCU must be recommended to all patients seen in the first hours after the presumed onset of the disease; after some delay (12 h?) systematic admission is not justified any more and the decision should be taken according to each case, in relation to the clinical status and familial or social conditions.