ICU Care for STEMI Associated With Improved Mortality Rates

Among ST-segment elevation myocardial infarction (STEMI) patients who could be treated in an intensive care unit (ICU) or a non-ICU unit, those treated in the ICU have improved mortality rates, according to a study published online in The BMJ.

Thomas S. Valley, M.D., from the University of Michigan in Ann Arbor, and colleagues evaluated the effect of ICU admission on mortality among 109,375 Medicare beneficiaries (≥65 years) with STEMI versus admission to a non-ICU unit (general/telemetry ward or intermediate care).

The researchers found that hospitals in the top quarter of ICU admission rates admitted ≥85 percent of STEMI patients to an ICU. ICU admission was associated with lower 30-day mortality rates compared with non-ICU admission (absolute decrease 6.1 percentage points; 95 percent confidence interval, −11.9 to −0.3) among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates. Among patients with non-STEMI, ICU admission was not associated with differences in mortality (absolute increase, 1.3 percentage points; 95 percent confidence interval, −0.9 to 3.4), in line with previous evidence.

"An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial," the authors write.

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