Early invasive revascularisation for patients critically ill after acute myocardial infarction: impact on outcome and ICU resource utilisation.

Objective: To assess the value of early invasive revascularisation for the initial management of critically ill patients after acute myocardial infarction in the daily, practice of a university-affiliated referral hospital and to gauge the impact of such a strategy on the intensive care unit. Patients and Methods: A prospective observational study on all patients admitted to the Royal North Shore hospital who had acute pulmonary oedema and/or shock prior to acute angiography for acute myocardial infarction from January 1st, 1998 to December 31st, 2001. Results: During the study period 846 patients with acute myocardial infarction had coronary artery angiography, 139 had acute pulmonary oedema and/or shock prior to angiography. The average age was 70 years, 65% of whom were male. Approximately 70% of these patients were admitted to the intensive care unit and coronary artery bypass surgery, was performed on 38%. Of those patients admitted to the intensive care unit, 95% required mechanical ventilation, 81% required inotropic support and 50% required intra-aortic balloon counterpulsation. In-hospital mortality was 32%, 6 weeks mortality was 38% and 6 month mortality was 42%. Conclusions: Our results confirm the benefit of early invasive revascularisation for critically, ill patients after acute myocardial infarction although a substantial amount of intensive care unit resources and cardiothoracic surgical expertise were required. (author abstract)