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Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

医学 重症监护室 急诊医学 心肌梗塞 回顾性队列研究 冠状动脉监护室 死亡率 置信区间 混淆 重症监护 队列研究 队列 急症护理 重症监护医学 内科学 医疗保健 经济 经济增长
作者
Thomas S. Valley,Theodore J. Iwashyna,Colin R. Cooke,Shashank S. Sinha,Andrew M. Ryan,Robert W. Yeh,Brahmajee K. Nallamothu
出处
期刊:BMJ [BMJ]
卷期号:: l1927-l1927 被引量:36
标识
DOI:10.1136/bmj.l1927
摘要

To evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).Retrospective cohort study.1727 acute care hospitals in the United States.Medicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015.30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI.The analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval -11.9 to -0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (-0.9 to 3.4) percentage points).ICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.
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