Original articleA description of the characteristics of patients with non-ST elevation acute coronary syndromes admitted to different settings in the 1990s
Introduction
Coronary care units (CCUs) were first developed in the 1960s to cater for the needs of patients with potentially life threatening cardiac conditions. In reality these facilities were used mainly for patients with acute myocardial infarction (AMI). Indeed it has been argued (Braunwald, 1998) that the CCU is the most important advance in the treatment of ST elevation MI. However more recently CCUs have been used for a wider group of patients including non-ST elevation acute coronary syndromes, severe arrhythmia and advanced heart failure.
The PRAIS (UK) study (Collinson et al., 2000) provided information on the characteristics and outcomes of patients with non-ST elevation acute coronary syndromes. However little is known about the differences in the characteristics of the patients who are admitted to highly resourced intensive care environments, e.g. CCU compared with those admitted to less intense care settings such as cardiology wards and general medical wards in the UK.
With the increased prevalence of non-ST elevation acute coronary syndromes in comparison with a reduction in prevalence of ST elevation MI (Kleiman and White, 2005) we analysed the characteristics of patients admitted to CCUs compared to other ward areas in the PRAIS-UK patient population.
Whilst these data relate to the late 1990s we felt that this information would provide a historical overview of care upon which more contemporary studies could draw comparisons when studying the evolution of cardiac care.
Section snippets
Methods
This investigation conforms with the principles outlined in the declaration of Helsinki and describes the results of a secondary analysis of the PRAIS (UK) study (Collinson et al., 2000). The study was approved by the UK Multi-Centre Research Ethics Committee, Local Research Ethics Committees and all patients gave their written informed consent prior to taking part in the study.
The original PRAIS (UK) study (Collinson et al., 2000) was undertaken as a prospective observational cohort registry
Baseline characteristics of patients compared by clinical setting
There were a number of statistically significant differences between the groups at baseline (Table 1). For example we discovered the proportion of male patients admitted to the CCU, cardiology ward and general medical ward were 66.4%, 57.3%, 54.1%, respectively. CCU patients were more likely to have a diagnosis of MI (8.4%, 4.8%, 1.6%) or diabetes (19.4%, 13.7%, 10.7%) or have ST depression on their admission ECG (25.2%, 18.3%, 13.1%) (Fig. 1). Conversely, patients presenting with a normal ECG
Discussion
Our study shows that patients admitted to CCU had certain higher risk features than those admitted to other ward areas, including ST depression and diabetes but also CCU patients were slightly younger and more likely to be male. There did not appear to be a systematic approach to deciding whether a patient should go to a particular care setting but the clearest trends favouring CCU admission were ECG ischaemia severity and the presence of diabetes.
Conversely, patients presenting with a normal
Acknowledgements
To the team at the Clinical Trials Unit at the Royal Brompton Hospital who were the author of the PRAIS (UK) study upon which this secondary analysis was based. Without their willingness to share these data this study would not have been possible.
References (29)
- et al.
Diabetic patients with acute coronary syndromes in the UK: high risk and under treated. Results from the prospective registry of acute ischaemic events syndromes in the UK (PRAIS-UK)
Int J Cardiol
(2005) Evolution of the management of acute myocardial infarction: a 20th Century saga
Lancet
(1998)- et al.
The electrocardiogram predicts one-year mortality of patients with unstable angina and non Q wave myocardial infarction: results of the TIMI registry ECG ancillary study
J Am Coll Cardiol
(1997) - et al.
A Description of the characteristics and outcome of patients hospitalised for acute chest pain in relation to whether they were admitted to the coronary care unit or not in the thrombolysis era
Int J Cardiol
(2002) - et al.
Treatment of a myocardial infarction in a coronary care unit. A two-year experience with 250 patients
Am J Cardiol
(1967) - et al.
Diabetes and long term risk of mortality from coronary and other causes in middle aged Swedish men. A general population study
Diabetes Care
(2001) - et al.
Cardiac specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes
New Engl J Med
(1996) - et al.
The TIMI risk score for unstable angina/non-ST elevation MI. A method for prognostication and therapeutic decision making
J Am Med Assoc
(2000) - et al.
Predictors of outcome in patients with acute coronary syndromes without persistent ST segment elevation results from an international trial of 9461 patients
Circulation
(2000) - et al.
Risk stratification in unstable angina. Prospective validation of the Braunwald classification
J Am Med Assoc
(1995)
Clinical outcomes, risk stratification and practice patterns of unstable angina and myocardial infarction without ST elevation: prospective registry of acute ischaemic syndromes in the UK (PRAIS-UK)
Eur Heart J
Managing high risk patients with acute coronary syndromes: the prospective registry of acute ischaemic events syndromes in the UK (PRAIS-UK)
Clin Med
The influence of age on policies for admission and thrombolysis in coronary care units in the United Kingdom
Age Ageing
A validated prediction model for all forms of acute coronary syndrome. Estimating the risk of 6 month post discharge death in an international registry
J Am Med Assoc
Cited by (3)
Leukocytosis as prediction for early and late complications in patient with st segment elevation myocardial infarction
2020, Indian Journal of Forensic Medicine and ToxicologyThe prognostic value of white blood cells count in patients with myocardial infarction
2015, Iranian Journal of Blood and Cancer