Safety and Cost Implications of General Ward versus Coronary Care Unit Admission After PCI for Stable STEMI: A Propensity-Matched Analysis.

BACKGROUND

Routine coronary care unit (CCU) admission after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) was affected during the COVID-19 pandemic. Infection control requirements require clinical assessment-based triaging to identify low-risk patients suitable for general ward admission. This study evaluated whether triaging clinically stable patients with STEMI (P-STEMI) to general wards is safe and cost-effective compared with CCU admission.

METHODS

This single-centre retrospective study included 486 P-STEMI who underwent PCI between January 2020 and December 2022; 82 were triaged to general wards and 404 to the CCU. A triage protocol based on COVID-19 testing status and clinical stability was implemented. Covariates were preselected using a directed acyclic graph (DAG) and balanced between groups via 1:1 propensity score matching. The primary outcome was total hospitalisation costs; secondary outcomes included in-hospital major adverse cardiovascular events (MACE) and length of stay.

RESULTS

In the original cohort, the general ward group had significantly lower costs (median $3515.59 vs $4057.86, p<0.001) and MACE rates (2.44% vs 16.83%; p<0.001). After PSM (76 patients each), general ward admission remained significantly associated with reduced hospitalisation costs (median $3515.15 vs $3798.86, p=0.049). However, the difference in MACE was no longer significant (2.63% vs 3.95%, p=0.649). No significant difference in LOS was observed. The Zwolle risk score demonstrated good predictive ability for in-hospital MACE (AUC=0.867).

CONCLUSION

For clinically stable P-STEMI post-PCI, triage to general wards was associated with significantly lower hospitalisation costs, and no statistically significant difference in MACE was observed.