Myocardial ischemia. Towards better use of the coronary care unit.

The coronary care unit is an expensive facility. Attempts to prove its value have not been successful, and the difficulty of doing so is considerable. In the absence of proof, it is nevertheless still necessary to establish a reasonable approach to the use of this facility. Such an approach and the evidence in its support are summarized. Pending the acquisition of more accurate predictors of risk, the following arbitrary guidelines are suggested. The coronary care unit is an appropriate environment for the management of dangerous arrhythmias and the major complications of infarction, for the management of resting angina until asymptomatic for 24 hours, and for the management of uncomplicated infarction in the absence of all predictors of risk for a period of 24 hours after the last episode of ischemic pain. Longer observation may be desirable for patients with certain predictors of short-term risk.