STEMI patients with primary PCI do not require Cardiac ICU admission: JAHA

Recent research found that patients with ST-segment-elevation myocardial infarction (STEMI) who receive a primary percutaneous coronary intervention (pPCI) may not need routine admission to a cardiac intensive care unit following reperfusion. The risk of developing an adverse event depended on the severity of the chronic kidney disease. The study was published in the Journal of the American Heart Association.  

Cardiac intensive care units were created for the patients during the prerevascularization era and were meant for the early recognition of ventricular arrhythmias following myocardial infarction. Patients with stable STEMI irrespective of the clinical risk or the provision of critical care therapies are still grouped in cardiac intensive care units after a pPCI even though Only 1 in 20 initially stable patients with STEMI receiving pPCI developed an in‐hospital adverse event. Hence researchers conducted a study to determine factors associated with in‐hospital adverse events in a hemodynamically stable, postreperfusion population of patients with STEMI between April 2012 and November 2019.

The study evaluated 2101 consecutive patients with STEMI who received pPCI in the Vancouver Coastal Health Authority. Patients were stratified into those with and without subsequent adverse events. Adverse events were categorized as cardiogenic shock, in‐hospital cardiac arrest, stroke, re‐infarction, and death. Multivariable logistic regression models were used to determine predictors of adverse events.

Findings of the study:  

• There were 1770 stable patients with STEMI who had received pPCI after excluding patients presenting with cardiac arrest, cardiogenic shock, or heart failure. 
• A total of 94 (5.3%) patients developed at least one adverse event like the cardiogenic shock 55 (3.1%), in‐hospital cardiac arrest 42 (2.4%), death 28 (1.6%), stroke 21 (1.2%), and re‐infarction 5 (0.3%).
• Univariable predictors of adverse events were older age, female sex, prior stroke, chronic kidney disease, and atrial fibrillation.
• There was no significant difference in reperfusion times between those with and without adverse events.
• Following multivariable adjustment, moderate to severe chronic kidney disease was associated with adverse events independent of reperfusion time, age, sex, smoking status, hypertension, diabetes, and prior myocardial infarction/PCI/coronary artery bypass grafting. 

Thus, the researchers concluded that the majority of patients with STEMI who receive pPCI may not require routine admission to a cardiac intensive care unit following reperfusion. 

For full reading, click here: https://doi.org/10.1161/JAHA.122.025572 

Amon J, Wong GC, Lee T, et al. Incidence and Predictors of Adverse Events Among Initially Stable ST-Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention. J Am Heart Assoc. 2022;11(17):e025572.