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Updated management of non-st-segment elevation acute coronary syndromes: selection of patients for low-cost care: an analysis of outcome and cost effectiveness

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

ID: 15385


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

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