Outcomes for Mechanically Ventilated Patients With Acute Myocardial Infarction Admitted to Medical vs Cardiac Intensive Care Units

Andi Shahu, MD, MHS; Sathvik Namburar, MD; Soumya Banna, MD; Alyssa Harris, MPH; Christopher Schenck, MD; Camila Trejo-Paredes, MD; Alexander Thomas, MD; Tariq Ali, MD, MBA; Anthony P. Carnicelli, MD; Christopher F. Barnett, MD, MPH; Michael A. Solomon, MD, MBA; P. Elliott Miller, MD, MHS

JACC: Advances (Sep 2024)

Outcomes for Mechanically Ventilated Patients With Acute Myocardial Infarction Admitted to Medical vs Cardiac Intensive Care Units

Andi Shahu, MD, MHS,
Sathvik Namburar, MD,
Soumya Banna, MD,
Alyssa Harris, MPH,
Christopher Schenck, MD,
Camila Trejo-Paredes, MD,
Alexander Thomas, MD,
Tariq Ali, MD, MBA,
Anthony P. Carnicelli, MD,
Christopher F. Barnett, MD, MPH,
Michael A. Solomon, MD, MBA,
P. Elliott Miller, MD, MHS

Affiliations

Andi Shahu, MD, MHS: Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
Sathvik Namburar, MD: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
Soumya Banna, MD: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
Alyssa Harris, MPH: Center for Advanced Analytics and Informatics, Vizient, Inc, Irving, Texas, USA
Christopher Schenck, MD: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
Camila Trejo-Paredes, MD: Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
Alexander Thomas, MD: Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
Tariq Ali, MD, MBA: Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
Anthony P. Carnicelli, MD: Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
Christopher F. Barnett, MD, MPH: Division of Cardiology, Department of Medicine, University of California, San Francisco, California, USA
Michael A. Solomon, MD, MBA: Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland, USA
P. Elliott Miller, MD, MHS: Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Address for correspondence: Dr P. Elliott Miller, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut 06517, USA.

Journal volume & issue: Vol. 3, no. 9
p. 101199

Abstract

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Background: Acute myocardial infarction (AMI) remains a common reason for admission to the intensive care unit (ICU). However, there is limited data comparing outcomes for patients with AMI admitted to specific ICUs. Objectives: The purpose of this study was to assess clinical outcomes between patients with AMI requiring invasive mechanical ventilation admitted to the medical ICU (MICU) compared to cardiac (CICU). Methods: We utilized the Vizient Clinical Data Base to identify patients with a primary diagnosis of AMI between October 2015 and December 2019 and requiring invasive mechanical ventilation. Using multivariable logistic regression, we compared clinical outcomes for patients admitted to the MICU vs CICU. Results: We identified 12,639 patients, 25.2% (n = 3,185) of which were admitted to a MICU and 74.8% (n = 9,454) to a CICU. Patients admitted to a CICU were more likely to present with STEMI (57.0% vs 42.8%), cardiogenic shock (46.0% vs 37.4%), and require mechanical circulatory support and vasoactive medications (all, P 750 beds), and teaching hospitals (all, P < 0.05). Conclusions: Admission to the CICU, as compared to MICU, was associated with lower in-hospital mortality for patients with AMI. These findings may support optimal triage of critically ill patients with AMI.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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