In the Journals

Patients may be overtreated in ICU after PCI

More than 80% of stable patients with STEMI who underwent PCI were treated in the ICU after the procedure although the risk for developing a complication was 16%, according to a study published in JACC: Cardiovascular Interventions.

“In recent years, treatment for STEMI patients has improved so much that cardiologists have seen the risk of developing a complication requiring care has significantly decreased,” Jay S. Shavadia, MD, cardiologist at Duke University Medical Center and researcher at the Duke Clinical Research Institute, said in a press release. “We wanted to quantify the risk and see whether ICUs are being overutilized for STEMI patients.”

Patients with STEMI

Researchers analyzed data from 19,507 patients (median age, 73 years; 39% women) from the National Cardiovascular Data Registry Chest Pain-MI Registry with STEMI who underwent PCI between April 2011 and December 2014. Patients were categorized by first medical contact to device times: early ( 60 minutes; n = 4,298; median age, 72 years; 35% women), intermediate (61 to 90 minutes; n = 8,737; median age, 73 years; 38% women) and late (> 90 minutes; n = 6,472; median age, 75 years; 43% women).

Of the patients in the study, 82% received treatment in the ICU after uncomplicated primary PCI for a median length of 1 day. The median first medical contact to device time was 79 minutes. The rate of ICU utilization was similar in the early (82%), intermediate (83%) and late reperfusion times (82%; P for trend = .44).

Complications that required care the ICU occurred in 16.2% of patients including cardiac arrest (4.1%), death (4.1%), stroke (1%), shock (9.8%), respiratory failure (6.4%) and high-grade atrioventricular block requiring treatment (4.6%).

Complications after PCI

The development of at least one complication was more common in patients in the intermediate (15.7%) and late groups (18.7%) compared with those in the early group (13.4%). The OR for patients in the intermediate group was 1.13 (95% CI, 1.01-1.25) and 1.22 for those in the late group (95% CI, 1.08-1.37).

“Improved prediction aimed at the timely identification of patients at greatest risk for developing complications could help in safety rationalizing ICU triage decisions for patients with STEMI,” Shavadia and colleagues wrote.

“The high ICU utilization pattern, despite declining complications following [primary] PCI, calls for a new approach,” Suartcha Prueksaritanond, MD, cardiovascular fellow at University of Kentucky College of Medicine in Lexington, and Ahmed Abdel-Latif, MD, PhD, associate professor at University of Kentucky College of Medicine, wrote in a related editorial. “This is particularly important because the overall health care cost continues to grow and calls for optimal resource utilization to prevail. Despite the assertion that [first medical contact to device] time is an important outcome predictor in elderly STEMI patients, studies challenging the outdated system-based practice with a more comprehensive yet simple-to-follow algorithm for risk stratification of STEMI patients are imperative.” – by Darlene Dobkowski

Disclosures: Shavadia, Prueksaritanond and Abdel-Latif report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

More than 80% of stable patients with STEMI who underwent PCI were treated in the ICU after the procedure although the risk for developing a complication was 16%, according to a study published in JACC: Cardiovascular Interventions.

“In recent years, treatment for STEMI patients has improved so much that cardiologists have seen the risk of developing a complication requiring care has significantly decreased,” Jay S. Shavadia, MD, cardiologist at Duke University Medical Center and researcher at the Duke Clinical Research Institute, said in a press release. “We wanted to quantify the risk and see whether ICUs are being overutilized for STEMI patients.”

Patients with STEMI

Researchers analyzed data from 19,507 patients (median age, 73 years; 39% women) from the National Cardiovascular Data Registry Chest Pain-MI Registry with STEMI who underwent PCI between April 2011 and December 2014. Patients were categorized by first medical contact to device times: early ( 60 minutes; n = 4,298; median age, 72 years; 35% women), intermediate (61 to 90 minutes; n = 8,737; median age, 73 years; 38% women) and late (> 90 minutes; n = 6,472; median age, 75 years; 43% women).

Of the patients in the study, 82% received treatment in the ICU after uncomplicated primary PCI for a median length of 1 day. The median first medical contact to device time was 79 minutes. The rate of ICU utilization was similar in the early (82%), intermediate (83%) and late reperfusion times (82%; P for trend = .44).

Complications that required care the ICU occurred in 16.2% of patients including cardiac arrest (4.1%), death (4.1%), stroke (1%), shock (9.8%), respiratory failure (6.4%) and high-grade atrioventricular block requiring treatment (4.6%).

Complications after PCI

The development of at least one complication was more common in patients in the intermediate (15.7%) and late groups (18.7%) compared with those in the early group (13.4%). The OR for patients in the intermediate group was 1.13 (95% CI, 1.01-1.25) and 1.22 for those in the late group (95% CI, 1.08-1.37).

“Improved prediction aimed at the timely identification of patients at greatest risk for developing complications could help in safety rationalizing ICU triage decisions for patients with STEMI,” Shavadia and colleagues wrote.

“The high ICU utilization pattern, despite declining complications following [primary] PCI, calls for a new approach,” Suartcha Prueksaritanond, MD, cardiovascular fellow at University of Kentucky College of Medicine in Lexington, and Ahmed Abdel-Latif, MD, PhD, associate professor at University of Kentucky College of Medicine, wrote in a related editorial. “This is particularly important because the overall health care cost continues to grow and calls for optimal resource utilization to prevail. Despite the assertion that [first medical contact to device] time is an important outcome predictor in elderly STEMI patients, studies challenging the outdated system-based practice with a more comprehensive yet simple-to-follow algorithm for risk stratification of STEMI patients are imperative.” – by Darlene Dobkowski

Disclosures: Shavadia, Prueksaritanond and Abdel-Latif report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.