Hülya ELLİDOKUZ, Hüseyin CAN, Selami DOĞAN, Hüseyin DURSUN, Dayimi KAYA

Long-term assessment of coronary care unit patient profile and outcomes: analyses of the 12-years patient records

Background/aim: The aim of this study was to determine the patient profile, treatment, and outcomes of a coronary care unit (CCU) by retrospective screening of 12-year patient records. Materials and methods: The data of 13,463 patients admitted to the CCU of a tertiary referral hospital between 1 January 1997 and 30 June 2008 were collected. The patients were assessed with respect to demographics, admission diagnosis, treatment, and outcomes. Results: The mean age of patients was 61 ± 13 years (66.7%, male). While the diagnosis of acute coronary syndrome (ACS) accounted for 65%, the rate of ST elevation myocardial infarction (STEMI) was 43.4%. Thrombolytic therapy was administered to 48.7% of the patients with STEMI. Systolic heart failure was the most frequent disease (11.9%) among the non-ACS diagnoses. The mortality rate of the CCU was 12.7% on average; it increased gradually after 2005 when the CCU became a general intensive care unit. Conclusion: This study is one of the largest comprehensive analyses of patient profile and outcomes of a CCU. Despite advances in the diagnosis and treatment of cardiac emergencies, the mortality rate of the CCU was high. Serving as a general intensive care unit, the absence of a coronary angiography laboratory and lower use of thrombolytic therapy for STEMI might be responsible factors.

PDF

___

1. Katz J, Becker R. Evolution of the Coronary Care Unit: Past, Present, and Future. In: Jeremias A, Brown D, editors. Cardiac Intensive Care. 2nd ed. Philadelphia, PA, USA: Saunders; 2010. pp. 1-8.
2. Morrow DA, Fang JC, Fintel DJ, Granger CB, Katz JN, Kushner FG, Kuvin JT, Lopez-Sendon J, McAreavey D, Nallamothu B et al. Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association. Circulation 2012; 126: 1408-1428.
3. Valente S, Lazzeri C, Sori A, Giglioli C, Bernardo P, Gensini GF. The recent evolution of coronary care units into intensive cardiac care units: the experience of a tertiary center in Florence. J Cardiovasc Med 2007; 8: 181-187.
4. Peterson ED, Shah BR, Parsons L, Pollack CV, French WJ, Canto JG, Gibson CM, Rogers WJ. Trends in quality of care for patients with acute myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J 2008; 156: 1045-1055.
5. Katz JN, Turee AT, Becker RC. Cardiology and the critical care crisis. A perspective. J Am Coll Cardiol 2007; 49: 1279-1282.
6. Gardini E, Caravita L, Ottani F, Ferrini D, Galvani M. Coronary care units: who to admit and how long. G Ital Cardiol 2007; 8 (Suppl 1): 5S-11S.
7. Hasin Y, Danchin N, Filippatos GS, Heras M, Janssens U, Leor J, Nahir M, Parkhomenko A, Thygesen K, Tubaro M et al, Working Group on Acute Cardiac Care of the European Society of Cardiology. Recommendations for the structure, organisation, and operation of intensive cardiac care units. Eur Heart J 2005; 26: 1676-1682.
8. Katz J, Shah B, Volz E, Horton JR, Shaw LK, Newby LK, Granger CB, Mark DB, Califf RM, Becker RC. Evolution of the coronary care unit: clinical characteristics and temporal trends in the healthcare delivery and outcomes. Crit Care Med 2010; 38: 375-381.
9. Casella G, Cassin M, Chiarella F, Chinaglia A, Conte MR, Fradella G, Lucci D, Maggioni AP, Pirelli S, Scorcu G et al; BLITZ-3 Investigators. Epidemiology and patterns of care of patients admitted to Italian Intensive Cardiac Care units: the BLITZ-3 registry. J Cardiovasc Med 2010; 11: 450-461.
10. Yıldız A, Güneş Y, Peker T, Çakar A, Biçeroğlu S, Pehlivanoğlu S, Enar R. Koroner bakım ünitesi hasta profili ve başvuran olguların sonuçları. MN Kardiyoloji 2007; 11: 171-175 (in Turkish).
11. Goodman SG, Huang W, Yan AT, Budaj A, Kennelly BM, Gore JM, Fox KAA, Goldberg RJ, Anderson FA for the Expanded Global Registry of Acute Coronary Events (GRACE) investigators. The expanded global registry of acute coronary events: baseline characteristics, management practices, and hospital outcomes of patients with acute coronary syndromes. Am Heart J 2009; 158: 193-201.
12. Ratcliffe AJ, Wilson E, Islam S, Platsman Z, Leou K, Williams G, Lucido D, Moustakakis E, Rachko M, Bergmann SR. Mortality in the coronary care unit. Coronary Artery Disease 2014; 25: 60-65.
13. Zobel C, Dörpinghaus M, Reuter H, Erdmann E. Mortality in a cardiac intensive care unit. Clinical Research in Cardiology 2012; 101: 521-524.
14. Kozan O, Enar R. TUMAR investigators. The effect of gender and inhospital outcome of acute myocardial infarction: the Turkish Acute Myocardial Infarction Study. Eur Heart J 2000; 21: (Suppl.) 181.
15. Fox KAA, Goodman SG, Klein W, Brieger D, Steg PG, Dabbous O, Avezum A, for the GRACE Investigators. Management of acute coronary syndromes. Variations in practice and outcome. Findings from the Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2002; 23: 1177-1189.
16. Widimsky P, Wijns W, Fajadet J, Belder M, Knot J, Aaberge L, Andrikopoulos G, Baz JA, Betriu A, Claeys M et al. on behalf of the European Association for Percutaneous Cardiovascular Interventions. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 2010; 31: 943-957.