APPARENTLY CORONARY HEART DISEASE-FREE PATIENTS IN THE CORONARY-CARE UNIT - CHARACTERISTICS, MEDICAL-CARE, AND 1-YEAR OUTCOME

Background: Coronary care units (CCUs) have contributed significantly to the improved survival rates among patients with acute myocardial in farction. Many patients admitted to CCUs are certified to be free of c oronary heart disease (CHD) at discharge. There is little literature o n the hospital course and prognosis of such patients. Methods: We iden tified and followed 594 patients admitted to six CCUs in the Minneapol is-St Paul metropolitan area in 1990 because of suspected acute myocar dial infarction who were eventually discharged without evidence of acu te or chronic CHD. Their baseline characteristics, medical care, and 1 -year outcome were compared with those of 672 patients with confirmed acute myocardial infarction and 612 patients with a history of CHD but without evidence of an acute coronary event. Results: Similar numbers of men and women were certified to be CHD-free on discharge from hosp ital. These patients were significantly younger than either patients w ith acute myocardial infarction or patients with a history of CHD (mea n age 57, 65, and 67 years, respectively). CHD-free patients commonly reported current smoking, hypertension, and hypercholesterolemia (26, 50, and 18%, respectively). These patients were less likely than those with acute myocardial infarction or a history of CHD to undergo diagn ostic or therapeutic procedures, or to receive pharmacological treatme nt. Their 1-year mortality rate was 5%, significantly lower (P<0.05) t han the mortality among patients with either acute myocardial infarcti on (18%) or a history of CHD (13%) but 2.6 times greater than expected in the general population. Older age, previous or current smoking, ch est pain leading to admission, and congestive heart failure were indep endent predictors of I-year mortality. Conclusions: Patients certified to be CHD-free after admission to a CCU with suspected acute myocardi al infarction have a lower 1-year mortality rate than patients experie ncing acute myocardial infarction or chronic CHD. Their mortality rate , however, is substantially higher than expected, probably because of a high prevalence of cigarette smoking and hypertension.