Patients admitted to the coronary care unit for chest pain: high risk subgroup for subsequent cardiovascular death.

Approximately 300 persons a year who are admitted to the Stanford University Hospital coronary care unit because of prolong ischemic chest pain and transient S-T changes do not manifest evidence of a myocardial infarction during their hospital stay. In a retrospective study carried out in 170 such patients, follow-up data obtained during a mean of 17.9 months revealed rates of mortality from cardiovascular causes of 4.2 percent for 1 month, 10.1 percent for 1 year and 19.7 percent for the entire follow-up period. Ten (40 percent) of the 23 deaths that occurred were sudden and 13 were due to acute myocardial infarction or its complications. Another 21 patients had a nonfatal myocardial infarction during this follow-up period. The data confirm the impression that patients with suspected myocardial infarction who do not have an infarction in the coronary care unit are at high risk for cardiovascular deaths after hospital discharge. Efforts are under way to define further a high risk subgroup on the basis of clinical indications before discharge.