Acute myocardial infarction in the elderly: influence of coronary care unit on mortality

One hundred consecutive patients aged 71-91 yr (average 78 yr) with acute myocardial infarction admitted initially to the coronary care unit (CCU) were compared with 84 patients aged 71-89 yr (average 78 yr) treated in the regular medical section during the same period. The mortality in patients in the CCU was slightly higher (48%) than the non CCU group (44%). There was no instance of primary electrial death in the CCU. By contrast, 30% of deaths in the regular medical section were ascribed to a documented or suspected primary arrhythmia, one third of which occurred in patients who had no complications. When both groups were classified according to initial clinical assessment, there was a clear tendency on the part of physicians to admit patients without complications to the general medical section. Among this latter group a small but significant risk due to potentially salvageable arrhythmias was observed. Conversely, there was no difference in mortality between CCU and non CCU patients who were initially admitted in congestive failure, pulmonary edema or shock. The study suggests that elderly patients sustaining an acute myocardial infarction and who are stable or in mild cardiac decompensation on initial clinical assessment are appropriate candidates for early admission to the CCU.