Author + information
- İlknur Çalpar1,
- Osman Şükrü Karaca1,
- Ahmet Büyük1,
- Cem Bostan1,
- Ahmet Yıldız1,
- Murat Kazım Ersanlı1,
- Seçkin Pehlivanoğlu2 and
- Rasim Enar3
Coronary care unıts (CCU) are specialised centers for performing monitorization, follow-up and treatment of coronary, noncoronary cardiac and other noncardiac emergencies. We aim to show the features of patients recieving care of coronary unit and to determine the changes of approach at a tertiary cardiac center in the same time period more than 10 years apart.
We included all consecutive patients hospitalized in the CCU between 1998 to 2013. We constitute 2 groups. Group 1 (between 1998 to 2002) had 2041, Group 2 (between 2011 to 2013) had 1181 patients. We compared diagnostic distributions, features of cases and in-hospital mortality rates between two groups.
The mean age and female gender distribution was 59±10 years, 24% in group 1, 63±12 years and 28% in group 2. Group 1 consists of 79% acute coronary syndromes (ACS) (59% ST elevated (STEMI), 41% nonST elevated); 9% ryhthm and conduction disturbances; 7% left ventricular heart failure and pulmonary edema; 1.9% cardiogenic shock and cardiopulmonary arrest; 3% others (Valvular heart diseases, aortic dissection, digital intoxication, pericardial effusion and tamponate, syncope, chronic obstructive pulmonary diseases etc.). Group 2 consists of 72% ACS (40% STEMI, 60% non ST elevated); 13% ryhthm and conduction disturbances; 9% left ventricular heart failure and pulmonary edema; 1.3% cardiogenic shock and cardiopulmonary arrest; 4,7% others (Valvular diseases, aortic dissection, digital intoxication, pericardial effusion and tamponate, syncope, chronic obstructive pulmonary diseases etc.) (Table 1).
Overall in-hospital mortality of groups was 9.0% and 4.4% respectively. (Table1) According to their diagnosis ıt was 6% for ACS (6% for STEMI; 5% for Non ST elevated) in group 1; 4.3% for ACS (5% for STEMI; 4.1% for Non ST elevated) in group 2. The revascularization strategy of two groups was different. Thrombolysis was 92% in group 1, whereas primary percutaneous coronary intervention was 98% in group 2. CCU length of stay was 6 ±4 day and 100 ± 15 hours in group 1, 4±3 day and 39±13 hours in group 2 for all patients and cases with ACS respectively.
ACS continue to be vast majority of cases in CCU. New pharmacologic and interventional strategies provide the notable reduction in mortality from ACS. It is noticed that there is a reduction in STEMI cases and increase in non ST elevation ACS and also age of ACS cases.
|Group 1 (n=2041)||Group 2 (n=1181)|
|Age average (year)||59||63|
|Acute coronary syndrome (%)||79||72|
|ST elevated ACS (All of ACS) (%)||59||40|
|Non ST elevated ACS (All of ACS) (%)||41||60|
|Rhythm and conduction abnormalities (%)||9||13|
|Heart failure and pulmonary edema (%)||7||9|
|Cardiogenic shock and cardiopulmonary arrest (%)||1,9||1,3|
|Others (Valvular heart diseases, aort dissection, pericardial diseases, syncope, pulmonary diseases, acute pulmonary embolism, etc) (%)||3||4,7|
|Hospital mortality (%)||9||4,4|
|Hospital mortality of ACS (%)||6||4,3|
|Hospital mortality of ST elevated ACS (%)||6||5|
|Hospital mortality of non ST elevated ACS (%)||5||4,1|
|Hospital mortality of rhythm and conduction abnormalities (%)||11||9|
|Hospital mortality of heart failure and pulmonary edema (%)||11||8|
|Hospital mortality of cardiogenic shock and cardiopulmonary arrest (%)||65||47|