Comparison of primary angioplasty in rural and metropolitan areas within an integrated network

Impact of High Care Unit Management on In-Hospital Mortality in Patients with ST-Elevation Myocardial Infarction

The impact of HCU management on the short-term prognosis of STEMI patients undergoing primary percutaneous coronary intervention (PCI) remains unclear.We retrospectively assessed 694 STEMI patients who underwent primary PCI at 8 regional general hospitals in Iwate Prefecture from 2014-2018. The patients were categorized based on the hospital to which they were admitted with or without HCUs (353 versus 341 patients, from 3 versus 5 hospitals, respectively). There was no significant between-group difference for overall in-hospital mortality (7% versus 10%, P = 0.174). However, in the Killip Class II or higher, in-hospital mortality was significantly lower among patients admitted to the HCU (20% versus 44%, P < 0.001). After propensity score matching, we found that overall in-hospital mortality was significantly lower in patients admitted to HCUs (2% versus 8%, P = 0.008). Furthermore, mortality rates for patients requiring mechanical ventilation or circulatory support were significantly lower for patients admitted to HCUs, with mortality rates of 30% versus 50% (P = 0.037).Our findings suggest that in hospitals without CCUs, systemic management through HCUs may significantly improve the survival prognosis of STEMI patients with Killip classification of II or higher.