Contemporary Characteristics of Patients Admitted with and without an ACS to the Intensive Cardiac Care Unit – Results from a Large Tertiary Center Registry. PLATIS-ICCU

Background: The current era intensive cardiac care unit (ICCU) is substantially different from the initial coronary care unit which evolved during the 1960’s caring for the peri-infarction patient. During the last decade there has been a substantial shift in patient characteristics, diagnoses, and procedures within the context of the ICCU. We evaluated the differences between patients with and without acute coronary syndromes (ACS) admitted to a large tertiary ICCU.

Methods: Consecutive cohort of all patients admitted to the ICCU during between 2014-2015. Patients were divided to those admitted with or without ACS. Groups were compared for baseline characteristics and in hospital-course.

Results: Overall 2103 consecutive patients were evaluated. Of these 1292 (62%) were hospitalized due to an ACS, as at least one of their hospitalization diagnosis. ACS patients were younger (64±12vs.67±18, p<0.0001), more likely to be male (77%vs.65%, p<0.0001), suffer from diabetes (36%vs.29%, p=0.002), and have a lower prevalence of comorbidities such as: renal failure (21%vs.14%, p<0.0001), malignancy (11%vs.14%, p=0.021), pulmonary hypertension (1% vs. 8%, p<0.0001), and anemia (10%vs.16%, p=0.001). Patients admitted with an ACS were more likely to undergo revascularization (70%vs.2% p<0.0001), and less likely to receive a pacemaker or a defibrillator (4%vs.18%, p<0.0001), blood transfusions (3%vs.7%, p<0.0001), and inotropic support (10%vs.20%, p<0.0001). ACS patients were less prone to suffer from malignant arrhythmias (3.7%vs.5.7%, p=0.03), bleeding events (2.2%vs.5.2%, p<0.0001), or acute renal failure (13%vs.7%, p<0.0001). Mortality did not differ between the two groups (2.6%vs.2.9%, p=0.76).

Conclusions: Nearly 40% of patients admitted to the ICCU have non-ACS related hospitalization. These, non-ACS patients have more comorbidities, as well as a more complicated in-hospital course than those admitted with an ACS, and pose a higher therapeutic burden on ICCU personnel.