• Yu-Shao Chou, Hsin-Yueh Lin, Yi-Ming Weng, Zhong Ning Leonard Goh, Cheng-Yu Chien, Hsuan-Jui Fan, Chih-Huang Li, Hsien-Yi Chen, Ming-Shun Hsieh, Joanna Chen-Yeen Seak, Chen-Ken Seak, and Chen-June Seak.
• Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, No. 5, Fusing St., Guei-shan Township, Taoyuan, 333, Taiwan, ROC.
• Intern Emerg Med. 2020 Jan 1; 15 (1): 59-66.

AbstractPercutaneous coronary interventions (PCIs) within a door-to-balloon timing of 90 min have greatly decreased mortality and morbidity of ST-elevation myocardial infarction (STEMI) patients. Post-PCI, they are routinely transferred into the coronary care unit (CCU) regardless of the severity of their condition, resulting in frequent CCU overcrowding. This study assesses the feasibility of step-down units (SDUs) as an alternative to CCUs in the management of STEMI patients after successful PCI, to alleviate CCU overcrowding. Criteria of assessment include in-hospital complications, length of stay, cost-effectiveness, and patient outcomes up to a year after discharge from hospital. A retrospective case-control study was done using data of 294 adult STEMI patients admitted to the emergency departments of two training and research hospitals and successfully underwent primary PCI from 1 January 2014 to 31 December 2015. Patients were followed up for a year post-discharge. Student t test and χ2 test were done as univariate analysis to check for statistical significance of p < 0.05. Further regression analysis was done with respect to primary outcomes to adjust for major confounders. Patients managed in the SDU incurred significantly lower inpatient costs (p = 0.0003). No significant differences were found between the CCU and SDU patients in terms of patient characteristics, PCI characteristics, in-hospital complications, length of stay, and patient outcomes up to a year after discharge. The SDU is a viable cost-effective option for managing STEMI patients after successful primary PCI to avoid CCU overcrowding, with non-inferior patient outcomes as compared to the CCU.

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