CLINICAL PROFILE OF PATIENTS ADMITTED TO THE CORONARY-CARE UNIT WITH POSSIBLE MYOCARDIAL-INFARCTION WITHOUT DIAGNOSTIC ECG AND OR ENZYME CHANGES

Concern has been expressed about the cost-effectiveness of the Coronar y Care Unit (CCU) and solution options offered on account of the large number of patients admitted to the CCU who turn out not to have acute myocardial infarction. In a prospective study over four years, we stu died a group of patients admitted to the CCU with suspected myocardial infarction but who did not have diagnostic ECG and/or enzyme changes for the causes of their chest pain. We compared the clinical profile o f these patients (Group A) with that of a random sample of patients wi th confirmed myocardial infarction (Group B). Gastrointestinal disorde rs, musculoskeletal chest pain, panic and anxiety disorders were the m ajor causes of chest pain in Group A patients. A normal ECG and a norm al creatine phosphokinase (CPK) within the first 24 hours, a normal in itial random blood sugar, a younger age and absence of coronary risk f actors effectively separated Group A patients as low risk from Group B patients as high risk for acute myocardial infarction. These simple p arameters will assist physicians providing CCU care in most hospitals in early decision making and in the judicious use of the CCU.