Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention

Objective: To analyze outcomes of patients with ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (PCI) triaged to the cardiac intensive care unit (CICU) vs a general telemetry unit by a Zwolle risk score–based algorithm. Methods: We intro...

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Autores principales:	John Z. Nan, MD, Jacob C. Jentzer, MD, Robert C. Ward, MD, Rachel J. Le, MD, Megha Prasad, MD, Gregory W. Barsness, MD, Rajiv Gulati, MD, PhD, Gurpreet S. Sandhu, MD, PhD, Malcolm R. Bell, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/495f750a1c534d82826923f2d0d5bfb1
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spelling	oai:doaj.org-article:495f750a1c534d82826923f2d0d5bfb12021-11-28T04:36:12ZSafe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention2542-454810.1016/j.mayocpiqo.2021.09.009https://doaj.org/article/495f750a1c534d82826923f2d0d5bfb12021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2542454821001521https://doaj.org/toc/2542-4548Objective: To analyze outcomes of patients with ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (PCI) triaged to the cardiac intensive care unit (CICU) vs a general telemetry unit by a Zwolle risk score–based algorithm. Methods: We introduced a quality improvement protocol in 2014 encouraging admission of STEMI patients with Zwolle score of 3 or less to general telemetry units unless they were hemodynamically unstable. We subsequently conducted a retrospective single-center cohort study of consecutive STEMI patients who had undergone primary PCI from January 1, 2014, to December 31, 2018. Outcomes studied include immediate complications, need for urgent unplanned intervention, need for CICU care, length of hospitalization, and survival. Results: We identified 547 patients, 406 with a Zwolle score of 3 or less. Of these, 192 (47.3%) were admitted to general telemetry and 214 (52.7%) to the CICU. Reasons for CICU admission included persistent chest pain, late presentation, and procedural complications. The average hospital length of stay was 2.1±1.4 days for non-CICU patients and 3.3±2.8 days for low-risk CICU patients (P<.001). Two patients initially admitted to general telemetry required transfer to the CICU. There were 26 patients who required unplanned cardiovascular intervention within 30 days, 5 from the general telemetry unit; 540 patients survived to discharge. One in-hospital death occurred among those initially triaged to the general telemetry unit, and this was due to a noncardiac cause. Conclusion: A Zwolle score–based algorithm can be used to safely triage post-PCI STEMI patients to a general telemetry unit.John Z. Nan, MDJacob C. Jentzer, MDRobert C. Ward, MDRachel J. Le, MDMegha Prasad, MDGregory W. Barsness, MDRajiv Gulati, MD, PhDGurpreet S. Sandhu, MD, PhDMalcolm R. Bell, MDElsevierarticleMedicine (General)R5-920ENMayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 5, Iss 6, Pp 1118-1127 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 John Z. Nan, MD Jacob C. Jentzer, MD Robert C. Ward, MD Rachel J. Le, MD Megha Prasad, MD Gregory W. Barsness, MD Rajiv Gulati, MD, PhD Gurpreet S. Sandhu, MD, PhD Malcolm R. Bell, MD Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention
description	Objective: To analyze outcomes of patients with ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (PCI) triaged to the cardiac intensive care unit (CICU) vs a general telemetry unit by a Zwolle risk score–based algorithm. Methods: We introduced a quality improvement protocol in 2014 encouraging admission of STEMI patients with Zwolle score of 3 or less to general telemetry units unless they were hemodynamically unstable. We subsequently conducted a retrospective single-center cohort study of consecutive STEMI patients who had undergone primary PCI from January 1, 2014, to December 31, 2018. Outcomes studied include immediate complications, need for urgent unplanned intervention, need for CICU care, length of hospitalization, and survival. Results: We identified 547 patients, 406 with a Zwolle score of 3 or less. Of these, 192 (47.3%) were admitted to general telemetry and 214 (52.7%) to the CICU. Reasons for CICU admission included persistent chest pain, late presentation, and procedural complications. The average hospital length of stay was 2.1±1.4 days for non-CICU patients and 3.3±2.8 days for low-risk CICU patients (P<.001). Two patients initially admitted to general telemetry required transfer to the CICU. There were 26 patients who required unplanned cardiovascular intervention within 30 days, 5 from the general telemetry unit; 540 patients survived to discharge. One in-hospital death occurred among those initially triaged to the general telemetry unit, and this was due to a noncardiac cause. Conclusion: A Zwolle score–based algorithm can be used to safely triage post-PCI STEMI patients to a general telemetry unit.
format	article
author	John Z. Nan, MD Jacob C. Jentzer, MD Robert C. Ward, MD Rachel J. Le, MD Megha Prasad, MD Gregory W. Barsness, MD Rajiv Gulati, MD, PhD Gurpreet S. Sandhu, MD, PhD Malcolm R. Bell, MD
author_facet	John Z. Nan, MD Jacob C. Jentzer, MD Robert C. Ward, MD Rachel J. Le, MD Megha Prasad, MD Gregory W. Barsness, MD Rajiv Gulati, MD, PhD Gurpreet S. Sandhu, MD, PhD Malcolm R. Bell, MD
author_sort	John Z. Nan, MD
title	Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention
title_short	Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention
title_full	Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention
title_fullStr	Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention
title_full_unstemmed	Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention
title_sort	safe triage of stemi patients to general telemetry units after successful primary percutaneous coronary intervention
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/495f750a1c534d82826923f2d0d5bfb1
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Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention

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