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J Intensive Care. 2018 Jan 25;6:5. doi: 10.1186/s40560-018-0275-y. eCollection 2018.

Clinical outcomes of patients undergoing primary percutaneous coronary intervention for acute myocardial infarction requiring the intensive care unit.

Author information

1
1Department of Anesthesia and Intensive Care, Papworth Hospital, Cambridge, England.
2
3Department of Critical Care Medicine, University of Calgary, ICU Administration - Ground Floor - McCaig Tower, Foothills Medical Center, 3134 Hospital Drive NW, Calgary, AB T2N 5A1 Canada.
3
4Department of Critical Care Medicine, University Hospitals of Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, England.
4
2Department of Interventional Cardiology, Papworth Hospital, Cambridge, England.

Abstract

Background:

Outcomes for patients with ST-segment elevation myocardial infarction continue to improve, largely due to timely provision of reperfusion by primary percutaneous coronary intervention (PPCI). However, despite prompt and successful PPCI, a small proportion of patients require ventilatory and hemodynamic support in an intensive care unit (ICU). The outcome of these patients remains poorly defined.

Methods:

A retrospective review of all consecutive admissions post-PPCI pathway to a single ICU between January 2009 and May 2014 was performed. Patients were analysed based on survival and indication for admission. Preadmission characteristics and ICU course were reviewed. Univariate and multivariable regression analysis was performed to determine predictors of outcome.

Results:

During the study period 2902 PPCI were performed and 101 patients were admitted to ICU following PPCI (incidence 3.5%). ICU mortality post-PPCI was 33.7%. Pre-ICU admission factors in a multivariable logistic regression analysis associated with increased mortality included requirement for an intra-aortic balloon pump and a high SOFA score.

Conclusions:

ICU admission post PPCI is associated with significant mortality. Mortality was related to high presenting SOFA score and need for IABP. These results provide important prognostic information and an acceptable method for risk-stratifying patients with acute myocardial infarction requiring intensive care.

KEYWORDS:

Acute myocardial infarction; Intensive care unit; Mechanical ventilation; Primary percutaneous coronary intervention

Conflict of interest statement

Ethical approval was obtained from the Papworth Hospital NHS Foundation Trust research and development board for the completion of this study.Not applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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