Abstract 12575: Feasibility of Management in General Ward Settings for Hemodynamic Stable Patients With Acute Myocardial Infarction

Abstract

Background: Although admission to the coronary care unit (CCU) is strongly recommended for ST-segment elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PPCI) by current guidelines, it remains unclear whether it is suitable for hemodynamically stable patients with acute myocardial infarction (AMI). The aim of this study was to evaluate the safety of management in the general ward (GW) in hemodynamically stable AMI patients after PPCI compared to the CCU. Methods: Using a large nationwide administrative database, a cohort of 19,426 patients who were diagnosed as AMI in 52 hospitals, which were capable of admission to CCU, between Jan 2015 and Dec 2019, was retrospectively analyzed. Patients with mechanical circulatory support and Killip classification 4, and without PPCI, on the day of admission were excluded. Consequently, 5,736 patients were divided into the CCU group (n=3,488) and the GW group (n=2,248) based on the type of hospitalization room on admission after PPCI. A propensity score-matched (PSM) analysis was performed between the 2 groups, and 1,690 pairs of patients were matched. Results: The CCU group showed a higher prevalence of Killip classification 3 and ambulance use compared to the GW group. In the PSM model, Kaplan-Meier curve analysis showed there was no significant difference in the incidence of 30 days in-hospital mortality (Log rank p=0.48). On the other hand, total cost of hospitalization was lower in the GW group. Multivariable analysis did not show the association of GW admission with 30 days in-hospital mortality (HR: 1.07, 95% CI: 0.63-1.82, p=0.795). Conclusions: Management in the GW was not associated with 30 days in-hospital mortality for hemodynamically stable AMI patients after PPCI compared to the CCU, whereas it reduced the total cost of hospitalization. It may be feasible for hemodynamically stable AMI patients to be admitted directly to the GW after PPCI.