OBJECTIVES: 

To compare the outcomes of patients with acute myocardial infarction who were treated in ICUs versus high-dependency care units (HDUs).

DESIGN: 

A nationwide, propensity score-matched, retrospective cohort study of a national administrative inpatient database in Japan from July 2010 to March 2018.

SETTING: 

Six hundred sixty-six acute-care hospitals with ICU and/or HDU beds covering about 75% of all ICU beds and 70% of all HDU beds in Japan.

PATIENTS: 

Adult patients who were hospitalized for acute myocardial infarction and admitted to the ICU or HDU on the day of hospital admission. Propensity score-matching analysis was performed to compare the inhospital mortality between patients treated in the ICU and HDU on the day of hospital admission.

INTERVENTIONS: 

ICU or HDU admission on the day of hospital admission.

MEASUREMENTS AND MAIN RESULTS: 

Of 135,142 eligible patients, 89,382 (66%) were admitted to the ICU and 45,760 (34%) were admitted to the HDU on the day of admission. After propensity score matching, there was no statistically significant difference in inhospital mortality between the ICU and HDU groups (5.0% vs 5.5%; difference, –0.5%; 95% CI, –1.0% to 0.1%). In the subgroup analyses, inhospital mortality was significantly lower in the ICU group than that in the HDU group among patients with Killip class IV (25.6% vs 28.4%; difference, –2.9%; 95% CI, –5.4% to –0.3%), patients who underwent intubation (40.0% vs 46.6%; difference, –6.6%; 95% CI, –10.6% to –2.7%), and patients who received mechanical circulatory support (21.8% vs 24.7%; difference, –2.8%; 95% CI, –5.5% to –0.2%).

CONCLUSIONS: 

Critical care in the ICU compared with that in the HDU was not associated with reduced inhospital mortality among the entire cohort of patients with acute myocardial infarction but was associated with reduced inhospital mortality among the subsets of patients with Killip class IV, intubation, or mechanical circulatory support.

中文翻译：

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急性心肌梗死患者的 ICU 与高依赖性护理病房：全国倾向评分匹配队列研究

目标： 

比较在 ICU 与高依赖护理病房 (HDU) 中接受治疗的急性心肌梗死患者的结局。

设计： 

对 2010 年 7 月至 2018 年 3 月日本国家行政住院患者数据库进行的全国性倾向评分匹配回顾性队列研究。

环境： 

666 家急症护理医院拥有 ICU 和/或 HDU 床位，约占日本所有 ICU 床位的 75% 和所有 HDU 床位的 70%。

患者： 

因急性心肌梗死住院并于入院当日入住 ICU 或 HDU 的成年患者。进行倾向评分匹配分析，比较入院当天在 ICU 和 HDU 接受治疗的患者的院内死亡率。

干预措施： 

入院当天入住 ICU 或 HDU。

测量和主要结果： 

在 135,142 名符合条件的患者中，入院当天，89,382 名患者（66%）入住 ICU，45,760 名患者（34%）入住 HDU。倾向评分匹配后，ICU 组和 HDU 组之间的院内死亡率没有统计学显着差异（5.0% vs 5.5%；差异，–0.5%；95% CI，–1.0% 至 0.1%）。在亚组分析中，Killip IV 级患者中 ICU 组的院内死亡率显着低于 HDU 组（25.6% vs 28.4%；差异，–2.9%；95% CI，–5.4% 至 –0.3%） ）、接受插管的患者（40.0% vs 46.6%；差异，–6.6%；95% CI，–10.6% 至 –2.7%），以及接受机械循环支持的患者（21.8% vs 24.7%；差异，–2.8） %；95% CI，–5.5% 至 –0.2%）。

结论： 

与 HDU 相比，ICU 的重症监护与整个急性心肌梗死患者队列的住院死亡率降低无关，但与 Killip IV 级、插管或机械循环患者亚组的住院死亡率降低相关支持。