In successive years since the opening of a Coronary Care Unit at Westminster Hospital the mortality has been 26 and 20% and for the first 4 months of 1968, 5·3%. Overall mortality for 260 patients was 20%.
Resuscitation has been successful in 59% of cardiac arrests within the unit and in 27% of those outside the unit caused by myocardial infarction. Seventeen patients left hospital alive and well who presumably would not have survived had they been treated at home.
Given efficient nursing staff and a resuscitation team, there can no longer be any justification for the treatment of patients with myocardial infarction anywhere other than in a coronary care unit, where such facilities are made available, providing admission is arranged within 3 days of the infarcting episode. The disadvantage of an ambulance journey to a patient with a recent infarct after this period of time may outweigh the advantage incurred by the coronary care unit.
The Peel Coronary Prognostic Index remains a very useful guide to prognosis in spite of this author's attempts to demonstrate any inaccuracies in its predictions.
A high (20%) ‘misdiagnosis’ rate must be accepted if some patients with bona fide myocardial infarction are not to be excluded from the unit.
The occurrence of 435 deaths reported to Her Majesty's Coroner for Westminster in the relevant period due to myocardial infarction suggests that the time may be ripe for a ‘flying squad’ resuscitation service in London.
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