ICU Care Not Needed by Majority of Heart Attack Patients

Most patients who undergo ST-elevation myocardial infarction (STEMI) are at relatively low risk of developing a complication requiring intensive care unit (ICU) attention, according to a new study.

Researchers at the Duke Clinical Research Institute (DCRI; Durham, NC, USA), Virginia Commonwealth University (Richmond, USA), and other institutions conducted a study to examine variability in ICU utilization for patients with uncomplicated STEMI, evaluate the proportion of these patients who developed in-hospital complications requiring ICU care, and assess whether ICU use patterns and complication rates varied across categories of first medical contact to device times.

The patient population included 19,507 stable STEMI patients treated at 707 hospitals across the United States. The overall results of the study revealed that 82.3% of the patients were treated in an ICU with a median one-day stay period, but that only 16.2% of them subsequently developed complications that actually required ICU care while they were hospitalized. Of these, 3.7% died, 3.7% experienced cardiac arrest, 8.7% experienced shock, 0.9% suffered a stroke, 4.1% underwent atrioventricular block, and 5.7% experienced respiratory failure.

The study also found that patients who waited longer for treatment were more likely to develop at least one complication, not limited to a complication related to cardiac issues. Those who received treatment within an hour of being evaluated by emergency medical service (EMS) personnel or going directly to the hospital without being seen by EMS, had a complication rate of 13.4%, compared with an 18.7% rate for those who were not treated within 90 minutes. The study was published on April 15, 2019, in JACC: Cardiovascular Interventions.

“In the era of rapid primary percutaneous coronary intervention, ICUs may be overutilized, as patients presenting with STEMI are less likely to develop complications requiring ICU care,” concluded lead author cardiologist Jay Shavadia, MD, of DCRI, and colleagues. “Implementing a risk-based triage strategy, inclusive of factors such as degree of reperfusion delay, could optimize ICU utilization for patients with STEMI.”

STEMI occurs from the occlusion of one (or more) of the coronary arteries that supply the heart with blood. The cause of this abrupt disruption of blood flow is usually plaque rupture, erosion, fissuring, or dissection that results in an obstructing thrombus. STEMI is characterized by an ST-segment elevation as detected on a 12-lead electrocardiogram (ECG). Signs and symptoms include chest pain or discomfort, shortness of breath, dizziness or light-headedness, nausea or vomiting, diaphoresis (sweat), anxiety, and palpitations.

Related Links:
Duke Clinical Research Institute
Virginia Commonwealth University