Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention.
Mayo Clin Proc Innov Qual Outcomes
Objective: To analyze outcomes of patients with ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (PCI) triaged to the cardiac intensive care unit (CICU) vs a general telemetry unit by a Zwolle risk score-based algorithm.
Methods: We introduced a quality improvement protocol in 2014 encouraging admission of STEMI patients with Zwolle score of 3 or less to general telemetry units unless they were hemodynamically unstable. We subsequently conducted a retrospective single-center cohort study of consecutive STEMI patients who had undergone primary PCI from January 1, 2014, to December 31, 2018. Outcomes studied include immediate complications, need for urgent unplanned intervention, need for CICU care, length of hospitalization, and survival.
Results: We identified 547 patients, 406 with a Zwolle score of 3 or less. Of these, 192 (47.3%) were admitted to general telemetry and 214 (52.7%) to the CICU. Reasons for CICU admission included persistent chest pain, late presentation, and procedural complications. The average hospital length of stay was 2.1±1.4 days for non-CICU patients and 3.3±2.8 days for low-risk CICU patients (
Conclusion: A Zwolle score-based algorithm can be used to safely triage post-PCI STEMI patients to a general telemetry unit.
Nan, John Z; Jentzer, Jacob C; Ward, Robert C; Le, Rachel J; Prasad, Megha; Barsness, Gregory W; Gulati, Rajiv; Sandhu, Gurpreet S; and Bell, Malcolm R, "Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention." (2021). Articles, Abstracts, and Reports. 5563.