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Alberto Conti, Filippo Pieralli, Lucia Sammicheli, Alberto Camaiti, Simone Vanni, Stefano Grifoni, Emilio Dovellini, David Antoniucci, Giovanni Squillantini, Francesco Mazzuoli, Giorgio Colombo
Med Sci Monit 2005; 11(3): CR100-108
Background: The management of patients with acute coronary syndromes without ST-segment elevation (NSTEACS) in a chest pain unit (CPU) should represent a cost-effective advantage over conventional management in a coronary care unit (CCU). However, the safety and advantages of this approach are still unresolved.
Material/Methods: Outcomes and management costs were evaluated in patients with NSTEACS with intermediate-high TIMI risk scores (≥3) randomized to receive management in a CPU or a CCU. Coronary events (CEs: angina, myocardial infarction, and death), revascularization, and resource utilization were compared between the two groups during hospital stay and at 6 months.
Results: Two hundred and ten patients were enrolled, 104 in the CPU and 106 in the CCU group. CEs were similar in both groups both during hospitalization (28% vs. 26%, respectively) and at 6 months (17% vs. 16%). Angiography was performed in 67% vs. 75%; CPU patients less frequently underwent revascularization (53% vs. 76%; p=0.002). In-hospital duration was similar in both groups (7.5 days vs. 5.7 days). CPU patients had a 22% reduction in overall hospitalization costs compared with conventional management (9,913 vs. 12,056 euros/patient; p=0.01). This gain was particularly relevant (29%) when patients with TIMI risk score