Document Detail

Outcomes in patients with myocardial infarction who are initially admitted to stepdown units: data from the Multicenter Chest Pain Study.
MedLine Citation:
PMID:  2195889     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To assess whether the admission of patients with chest pain to a stepdown unit would jeopardize the outcome of those patients who ultimately "ruled in" for a myocardial infarction. PATIENTS AND METHODS: We compared the risk of an adverse outcome in initially uncomplicated, "rule-out myocardial infarction" patients who were admitted directly to a stepdown unit (n = 58) or to a coronary care unit (n = 409) at 6 hospitals and who then ultimately "ruled in" for a myocardial infarction. RESULTS: An adverse outcome (death, serious complication, or invasive intervention) occurred in 16 (28%) stepdown unit patients compared with 159 (39%) coronary care unit patients. Among patients eligible for initial care in either location, the risk of an adverse outcome after controlling for clinical characteristics was similar in the two groups using each of two different multivariate approaches. CONCLUSION: Although our study was not of sufficient size to exclude the possibility of a small benefit from initial triage to a coronary care unit, our data suggest that (1) admission of initially uncomplicated chest pain patients with a relatively low probability of acute myocardial infarction to a stepdown unit does not seriously jeopardize those who eventually "rule in" for myocardial infarction; and (2) larger observational or randomized studies, which could reduce the residual possibility of somewhat higher risk in the stepdown unit, would be ethical to perform.
N H Fiebach; E F Cook; T H Lee; D A Brand; G W Rouan; M Weisberg; L Goldman
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American journal of medicine     Volume:  89     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  1990 Jul 
Date Detail:
Created Date:  1990-08-15     Completed Date:  1990-08-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  15-20     Citation Subset:  AIM; IM    
Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
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MeSH Terms
Coronary Care Units
Hospital Units*
Middle Aged
Multicenter Studies as Topic
Myocardial Infarction / complications,  diagnosis*,  mortality
Outcome and Process Assessment (Health Care)
Patient Admission
Prospective Studies
Grant Support

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