Although the majority of STEMI patients are treated in the ICU after undergoing PCI, only 16 percent develop complications that require ICU care, according to a study published April 15 in JACC: Cardiovascular Interventions.

Jay S. Shavadia, MD, et al., used ACC's Chest Pain – MI Registry to examine patterns of ICU use in STEMI patients age 65 and older who had been treated with primary PCI. The researchers stratified data into three categories based on the timing of reperfusion: early (first medical contact to device time of 60 minutes or less); intermediate (61 to 90 minutes); or late (greater than 90 minutes).

Of 19,507 STEMI patients at 707 hospitals, 16,047 (82.3 percent) were treated in an ICU with a median stay of one day. The median FMC to device time was 79 minutes, with 20 percent of patients receiving early contact, 44.8 percent intermediate, and 33.2 percent late reperfusion. Overall, 3,159 patients (16.2 percent) developed complications that required ICU care, including death (3.7 percent); cardiac arrest (3.7 percent); shock (8.7 percent); stroke (0.9 percent); high-grade atrioventricular block (4.1 percent); and respiratory failure (5.7 percent). There was no difference in ICU care between patients with early, intermediate or late reperfusion times. Patients who received treatment within an hour had a complication rate of 13.4 percent, compared with 18.7 percent for those who were not treated for at least 90 minutes.

The researchers concluded that although more than 80 percent of STEMI patients receive ICU care after primary PCI, the risk of developing a complication that requires an ICU stay is 16 percent. "Improved prediction aimed at the timely identification of patients at greatest risk for developing complications could help in safely rationalizing ICU triage decisions," they conclude.

In an accompanying editorial comment, Suartcha Prueksaritanond, MD, and Ahmed Abdel-Latif, MD, PhD, write that a "new approach" is needed to determine which STEMI patients should be admitted to the ICU, adding this is "particularly important as the overall health care cost continues to grow and calls for optimal resource utilization prevail."

Keywords: Triage, Atrioventricular Block, Chest Pain, Chest Pain MI Registry, Registries, National Cardiovascular Data Registries, Reperfusion, Stroke, Percutaneous Coronary Intervention, Respiratory Insufficiency, Heart Arrest, Intensive Care Units

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