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Step-down units are cost-effective alternatives to coronary care units with non-inferior outcomes in the management of ST-elevation myocardial infarction patients after successful primary percutaneous coronary intervention

  • Yu-Shao Chou
  • Hsin-Yueh Lin
  • Yi-Ming Weng
  • Zhong Ning Leonard Goh
  • Cheng-Yu Chien
  • Hsuan-Jui Fan
  • Chih-Huang Li
  • Hsien-Yi Chen
  • Ming-Shun Hsieh
  • Joanna Chen-Yeen Seak
  • Chen-Ken Seak
  • Chen-June SeakEmail author
IM - ORIGINAL
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Abstract

Percutaneous coronary interventions (PCIs) within a door-to-balloon timing of 90 min have greatly decreased mortality and morbidity of ST-elevation myocardial infarction (STEMI) patients. Post-PCI, they are routinely transferred into the coronary care unit (CCU) regardless of the severity of their condition, resulting in frequent CCU overcrowding. This study assesses the feasibility of step-down units (SDUs) as an alternative to CCUs in the management of STEMI patients after successful PCI, to alleviate CCU overcrowding. Criteria of assessment include in-hospital complications, length of stay, cost-effectiveness, and patient outcomes up to a year after discharge from hospital. A retrospective case–control study was done using data of 294 adult STEMI patients admitted to the emergency departments of two training and research hospitals and successfully underwent primary PCI from 1 January 2014 to 31 December 2015. Patients were followed up for a year post-discharge. Student t test and χ2 test were done as univariate analysis to check for statistical significance of p < 0.05. Further regression analysis was done with respect to primary outcomes to adjust for major confounders. Patients managed in the SDU incurred significantly lower inpatient costs (p = 0.0003). No significant differences were found between the CCU and SDU patients in terms of patient characteristics, PCI characteristics, in-hospital complications, length of stay, and patient outcomes up to a year after discharge. The SDU is a viable cost-effective option for managing STEMI patients after successful primary PCI to avoid CCU overcrowding, with non-inferior patient outcomes as compared to the CCU.

Keywords

ST-elevation myocardial infarction Step-down unit Coronary care unit Cost analysis 

Notes

Acknowledgements

We would like to thank Nian-Ting Shie and Chia-Hsun Chang for their assistance in analysing part of the data. This study was supported by Chang Gung Memorial Hospital in Taiwan [Grant numbers CORPG3F0931, CPRPG3D0012]. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The authors have nevertheless obtained ethical approval from the Chang Gung Memorial Hospital Institutional Review Board (IRB 105-1789D).

Informed consent

For this type of study formal consent is not required.

Data availability statement

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  • Yu-Shao Chou
    • 1
    • 2
  • Hsin-Yueh Lin
    • 1
    • 2
  • Yi-Ming Weng
    • 3
  • Zhong Ning Leonard Goh
    • 4
  • Cheng-Yu Chien
    • 5
  • Hsuan-Jui Fan
    • 1
    • 2
  • Chih-Huang Li
    • 1
    • 2
  • Hsien-Yi Chen
    • 1
    • 2
  • Ming-Shun Hsieh
    • 6
    • 7
    • 8
  • Joanna Chen-Yeen Seak
    • 9
  • Chen-Ken Seak
    • 9
  • Chen-June Seak
    • 1
    • 2
    • 8
    Email author
  1. 1.Department of Emergency MedicineLin-Kou Medical Center, Chang Gung Memorial HospitalTaoyuanTaiwan, ROC
  2. 2.College of MedicineChang Gung UniversityTaoyuanTaiwan
  3. 3.Division of Prehospital Care, Department of Emergency MedicineTaoyuan General Hospital, Ministry of Health and WelfareTaoyuanTaiwan
  4. 4.School of MedicineInternational Medical UniversityKuala LumpurMalaysia
  5. 5.Department of Emergency MedicineTon-Yen General HospitalZhubeiTaiwan
  6. 6.Department of Emergency MedicineTaipei Veterans General Hospital, Taoyuan BranchTaoyuanTaiwan
  7. 7.School of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  8. 8.Institute of Occupational Medicine and Industrial Hygiene, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
  9. 9.Sarawak General HospitalKuchingMalaysia

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