Hospital triage of acute myocardial infarction: Is admission to the coronary care unit still necessary?

Index of Microcirculatory Resistance at the Time of Primary Percutaneous Coronary Intervention Predicts Early Cardiac Complications: Insights From the OxAMI (Oxford Study in Acute Myocardial Infarction) Cohort

“…The risk stratification of patients with an acute myocardial infarction has been a longstanding clinical challenge 3, 21. Current international guidelines suggest that PPCI patients with a “low‐risk of complications” might be candidates for non‐ICU admission5 and early discharge2 and mention the PAMI‐II and Zwolle scores as useful risk‐stratification tools 17, 18…”

“…Improved methods of identifying risk may have important implications for clinical management, for example, in terms of intensity of monitoring and duration of admission . The American College of Cardiology/American Heart Association and European Society of Cardiology guidelines suggest that PPCI patients with a “low risk of complications” might be candidates for non‐ICU admission and early discharge .…”

A user-friendly risk-score for predicting in-hospital cardiac arrest among patients admitted with suspected non ST-elevation acute coronary syndrome – The SAFER-score

“…The CCU was introduced in the early 1960s, enabling patients with ACS to have continuous ECG monitoring where life-threating arrhythmias could be swiftly detected and treated by trained personnel 13 . With the development and improvement of care and outcomes for patients with ACS, questions have been raised about the need and cost effectiveness for lowrisk patients to be admitted to the CCU 14 . Current guidelines recommend that patients with non-ST elevation myocardial infarction and low risk for arrhythmias could be initially monitored in a CCU or an intermediate care unit likewise 5 .…”

The necessity of conversion from coronary care unit to the cardiovascular intensive care unit required for cardiologists

“…Meanwhile, in patients with medically complex conditions admitted to intensive care unit (ICU) or CCU, the ratio of acute coronary syndrome in ICU or CCU has decreased relatively [3]. Therefore, there is a recognition that ICU management is not necessary for AMI without complications [4], and cardiologists' care at all times has decreased [5,6]. In addition to cardiogenic shock due to AMI, there is an increase in other cardiovascular diseases including intractable heart failure accompanying multiple comorbidities.…”