Treatment of myocardial infarction in a coronary care unit: A Two year experience with 250 patients

doi:10.1016/0002-9149(67)90023-9

The American Journal of Cardiology

Volume 20, Issue 4, October 1967, Pages 457-464

https://doi.org/10.1016/0002-9149(67)90023-9 Get rights and content

Abstract

The results of treatment of 250 patients with established acute myocardial infarction in a coronary care unit in a university hospital are described. The criteria for diagnosis have been carefully defined. In 62 per cent of patients admitted with a tentative diagnosis of acute infarction, the initial impression was confirmed. Fifteen per cent of patients admitted to the unit were classified as having possible infarction; in this group, the mortality rate was 3 per cent. A classification of functional severity based on clinical evidence of heart failure or shock is presented.

Morbidity and mortality in acute myocardial infarction are related to the functional severity of the illness. Although arrhythmia is common, the overriding importance of five life-threatening arrhythmias is emphasized. Mortality of patients in the coronary care unit was not improved in comparison to those treated under regular care until strong central direction of therapeutic programs, immediate treatment of arrhythmia in cardiac arrest, and delegation of some medical authority to trained nurses was accomplished. The change in concept of the purposes and practices of special coronary care from resuscitation to prevention of arrhythmia is emphasized.

The mortality in myocardial infarction complicated by shock remains high. In the absence of shock, aggressive medical treatment in the coronary care unit reduced mortality from 26 to 7 per cent. The implications of these data in the management of patients admitted to a hospital with a diagnosis of acute myocardial infarction are discussed.

References (17)

H.W. Day
An intensive coronary care area
Dis. Chest
(1963)
K.W.G. Brown et al.
Coronary unit, an intensive care centre for acute myocardial infarction
Lancet
(1963)
W.F. Minogue et al.
External cardiac massage for cardiac arrest due to myocardial infarction. A changing concept
Am. J. Cardiol.
(1964)
G.A. Klassen et al.
Cardiac resuscitation in 126 medical patients using external cardiac massage
Lancet
(1963)
H.W. Day
Effectiveness of an intensive coronary care unit
Am. J. Cardiol.
(1965)
T. Killip et al.
Experience with monitoring myocardial infarction of the New York Hospital-Cornell Medical Center, Comparison of regular hospital care and coronary unit care
J.T. Kimball et al.
Comparison of coronary unit and regular hospital care in acute myocardial infarction
Circulation
(1966)
Kimball, J. T. and Killip, T. Unpublished...

There are more references available in the full text version of this article.

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^☆: From the Department of Medicine, Cornell University Medical College, New York, N.Y. This study was supported by Contract No. PH 108-65-09 with the U. S. Public Health Service, Department of Health, Education, and Welfare.

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Symposium on coronary care unitTreatment of myocardial infarction in a coronary care unit: A Two year experience with 250 patients☆

Abstract

Dis. Chest

Lancet

Am. J. Cardiol.

Lancet

Am. J. Cardiol.

Experience with monitoring myocardial infarction of the New York Hospital-Cornell Medical Center, Comparison of regular hospital care and coronary unit care

Comparison of coronary unit and regular hospital care in acute myocardial infarction

Circulation

Symposium on coronary care unit
Treatment of myocardial infarction in a coronary care unit: A Two year experience with 250 patients☆