Circulation, Vol 51, 410-413, Copyright © 1975 by American Heart Association
JF McNeer, AG Wallace, GS Wagner, CF Starmer and RA Rosati
This report represents our experience with 522 consecutive patients with
acute myocardial infarction admitted directly to the Duke Coronary Care
Unit. Fifty items of information were used to characterize the patients,
their hospital course and follow-up. Serious complications included death,
ventricular tachycardia or fibrillation, second- or third-degree heart
block, pulmonary edema, cardiogenic shock, persistent sinus tachycardia or
hypotension, atrial flutter or fibrillation, and extension of infarction.
Forty-nine percent of the patients (252 of 522) experienced a serious
complication. All patients who experienced any serious complications had at
least one of the above during the first four days of hospitalization.
Patients who survived through day 4 were subgrouped on the basis of the
occurrence (complicated) or lack of occurrence (uncomplicated) of the above
on day 5. Complicated patients had a subsequent hospital mortality of 14%
and an incidence of late serious complications of 51%. Patients who were
uncomplicated through day 4 had a subsequent hospital mortality of zero and
an incidence of late serious complications of zero. These data suggest that
it would be feasible and ethically justified to conduct a prospective
clinical trial of early discharge (7th day) in patients who meet the above
criteria for uncomplicated. The potential economic savings through earlier
discharge in uncomplicated patients are of major significance.
ARTICLES
The course of acute myocardial infarction. Feasibility of early discharge of the uncomplicated patient
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