The current status of coronary care units in the treatment of acute myocardial infarction.

Intensive monitoring for patients suffering from acute myocardial infarction first began in USA in 1962. In the past 2 decades, major progress has taken place in the development of coronary care units. The first coronary care unit in Singapore was introduced in 1967. Review of the results obtained from this unit shows that the hospital mortality from acute myocardial infarction can be lowered by intensive cardiac monitoring because of better treatment of cardiac arrhythmias and cardiac failure. However, the outcome of patients with cardiogenic shock is still dismally poor and the mortality in this group of patients is about 85 to 100%. Although the hospital mortality of acute myocardial infarction has been decreased with the introduction of coronary care units, the mortality of this condition in the community is still distressingly high. This is so because the majority of deaths in acute myocardial infarction occur early and outside the hospital environment. Currently the salvage of ischaemic myocardium and the continuing search for an effective treatment for severe pump failure remains the greatest challenge in the present and future management of acute myocardial infarction.