Key result
In critically ill patients without acute coronary syndrome, high cardiac troponin elevation was associated with increased 30-day mortality (OR 1.82) compared to no elevation, while statins, β-blockers, and aspirin were associated with reduced mortality in a troponin-dependent manner.
Why the study?
Does the administration of statins, beta-blockers, or aspirin reduce 30-day mortality in critically ill patients without acute coronary syndromes based on cardiac troponin levels?
Cohort (n=19,979)
Yes
Does the administration of statins, beta-blockers, or aspirin reduce 30-day mortality in critically ill patients without acute coronary syndromes based on cardiac troponin levels?
In critically ill patients without acute coronary syndromes, statins are associated with reduced 30-day mortality in those with no or intermediate troponin elevation, while beta-blockers and aspirin are associated with reduced mortality in those with high troponin elevation.
Should not yet change practice in non-ACS critical illness; hypothesis-generating for troponin-stratified cardioprotection and requires RCTs.
BACKGROUND: Elevated cardiac troponin (cTn) in the absence of acute coronary syndromes (ACS) is associated with increased mortality in critically ill patients. There are no evidence-based interventions that reduce mortality in this group. OBJECTIVES: We performed a retrospective investigation of the Veterans Administration Inpatient Evaluation Center database to determine whether drugs used in ACS (β-blockers, aspirin, and statins) are associated with reduced mortality in critically ill patients. METHODS: Thirty-day mortality was determined for non-ACS patients admitted to any Veterans Administration Intensive Care Unit between October 1, 2007, and September 30, 2008, adjusted for severity of illness. Troponin assay values were normalized across institutions. RESULTS: Multivariate analyses for 30-day mortality showed an odds ratio (OR) of 1.82 for patients with high cTn (P < 0.0001, cTn > 10% coefficient of variation) and 1.18 for intermediate cTn (P = 0.0021, cTn between lowest limit detectable and 10% coefficient of variation) compared with patients with no elevation, adjusting for severity of illness (n = 19,979). Logistic regression models showed that patients with no or intermediate elevations of cTn taking statins within 24 hours of cTn measurement had a lower mortality than patients not taking statins (OR, 0.66; 95% confidence interval [95% CI], 0.53-0.82; P = 0.0003), whereas patients with high cTn had a lower mortality if they were taking β-blockers or aspirin within 24 hours of cTn measurement compared to patients not taking β-blockers or aspirin (β-blockers: OR, 0.80; 95% CI, 0.68-0.94; P = 0.0077; aspirin: OR, 0.81;95% CI, 0.69-0.96; P = 0.0134). CONCLUSIONS: This retrospective study confirms an association between elevated troponin and outcomes in critically ill patients without ACS and identifies statins, β-blockers, and aspirin as potential outcome modifiers in a cTn-dependent manner.
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Poe et al. (2015) conducted a cohort in Critically ill without acute coronary syndrome (n=19,979). High cardiac troponin (cTn) elevation vs. No cTn elevation was evaluated on 30-day mortality (OR 1.82, 95% CI 1.62-2.04, p=<0.0001). In critically ill patients without acute coronary syndrome, high cardiac troponin elevation was associated with increased 30-day mortality (OR 1.82) compared to no elevation, while statins, β-blockers, and aspirin were associated with reduced mortality in a troponin-dependent manner.
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