The difficulty in distinguishing the type of occlusive coronary artery disease among patients with sepsis in the emergency department: a multicenter retrospective cohort study

Purpose: Distinguishing true obstructive coronary artery disease (OCAD) from myocardial infarction (MI) resulting from a mismatch between oxygen supply and demand (T2MI) in patients with sepsis is difficult. This study aimed to assess the clinical presentation and laboratory biomarkers of OCAD in patients with sepsis in the emergency department. Materials and Methods: This was a multicenter retrospective cohort study. We included patients diagnosed with sepsis or septic shock in the emergency department between January 2010 and December 2017 and who underwent coronary angiography in the emergency department for suspected concomitant MI. The patients were categorized into the mixed MI group, for those who had significant coronary occlusion superimposed on type 2 MI or the pure type 2 MI (T2MI) group. Results: A total of 71 patients were included after exclusion. Forty patients (56.3%) had OCAD (mixed MI). Fever (25% vs. 15%) and high scores of quick sequential organ failure assessment (qSOFA score) (35.5% vs. 27.5%) were more frequent in the T2MI group, and the troponin-I level was more elevated in the mixed MI group, but the difference was not significant. The most common focus of infection was pulmonary. Sepsis patients with OCAD tended to have longer admissions in the intensive care unit and ward admission days. However, the proportion of mortality and shock events was similar to T2MI group after percutaneous coronary artery intervention (PCI) treatment. Conclusions: Differentiating between mixed MI from pure T2MI through clinical presentation or laboratory results in patients with sepsis with suspected myocardial infarctions remains difficult. Lowering the threshold of coronary artery angiography may play a critical role in differentiating OCAD from T2MI.