Benefits obtained by the introduction of a coronary-care unit. A comparative study.

. During the period Nov. 24, 1967, to Dec. 31, 1968, a prospective study was performed, comparing the mortality among patients with acute myocardial infarction treated in a coronary-care unit and patients treated in departments of general medicine. All patients suspected of having acute myocardial infarction were accepted, without any limitation, in the coronary-care unit if a bed with monitoring apparatus was unoccupied. If the four monitored beds were occupied, the patients were admitted direct to one of the other two departments of general medicine of the same hospital, serving as control departments. A total of 328 patients were admitted to the coronary-care unit and 484 to the control departments as suspected of acute myocardial infarction. In accordance with firmly established criteria, the diagnosis could be confirmed in about 50% of the cases in both groups, viz. in 171 patients in the coronary-care unit and in 244 in the control departments. The two groups were comparable in respect to the majority of important parameters, but there was a preponderance of patients with obesity. congestive heart failure, short duration of symptoms, and anterior-wall infarctions in the coronary-care unit group. The overall mortality in the coronary-care unit group was 17.6% as compared with 41.4% in the control group. Within the various age groups the mortality was consistently lower in the coronary-care group. It is concluded that the better results obtained in the coronarycare unit seem to be due to a selective, individualized prophylaxis based upon intensive observation, early detection and treatment of arrhythmias, and a schedule for slow reduction of drug therapy under close observation to detect the slightest signs of relapse.