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 revascularization 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 1(st), 1998 to December 31, 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.