Highlights
- •Almost all NSTEMI patients were admitted to the ICU as it was a hospital routine.
- •Complications requiring ICU care were infrequent.
- •Most of the study population had a low ACTION ICU risk score.
- •The ACTION risk score had low accuracy in the prediction of these complications.
Abstract
Background
The decision on whether non-ST-segment elevation myocardial infarction (NSTEMI) patients
should be admitted to intensive care units (ICU) takes into account several factors
including hospital routines. The Acute Coronary Treatment and Intervention Outcomes
Network (ACTION) ICU score was developed to predict complications requiring ICU care
post-NSTEMI.
Methods
We described patient characteristics and clinical outcomes of 1263 NSTEMI patients
admitted to a private hospital in Sao Paulo, Brazil, from 2014 to 2018. We also aimed
to retrospectively identify NSTEMI patients who might not have needed to be admitted
to the ICU based on the ACTION ICU risk score. We defined complications requiring
ICU care post-NSTEMI as cardiac arrest, cardiogenic shock, stroke, re-infarction,
death, heart block requiring pacemaker placement, respiratory failure, or sepsis.
Results
Mean age was 62.3 years and 35.8% were female. A total of 94.6% of NSTEMI patients
were admitted to the ICU. Most NSTEMI patients (91.9%) underwent coronary angiography.
Percutaneous coronary intervention was performed in 47.1% and coronary artery bypass
graft surgery in 10.3%. Complications requiring ICU care occurred in 62 patients (4.9%).
In-hospital mortality rate was 1.3%. Overall, 70.4% had an ACTION ICU score ≤ 5. The
C-statistics for the ACTION risk score to predict complications was 0.55 (95% confidence
interval 0.47–0.63).
Conclusions
Complications requiring ICU care were infrequent in a cohort of NSTEMI patients who
were routinely admitted to the ICU over a 4-year period. The ACTION risk score had
low accuracy in the prediction of complications requiring ICU care in our population.
Keywords
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Article info
Publication history
Published online: February 20, 2020
Accepted:
February 11,
2020
Received in revised form:
January 28,
2020
Received:
December 3,
2019
Identification
Copyright
© 2020 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
