Among critically ill patients admitted for non-cardiac reasons, 41% met criteria for possible or definite myocardial infarction, which was associated with a 180-day mortality of 46% compared to 4% in patients with normal troponin.
Cohort (n=144)
No
Does serial troponin measurement identify unrecognized myocardial infarction and predict mortality in ICU patients admitted for non-cardiac diagnoses?
Serial troponin monitoring in non-cardiac ICU patients reveals a high incidence of unrecognized myocardial infarction that is associated with significantly increased short- and long-term mortality.
Absolute Event Rate: 46% vs 4%
p-value: p=0.006
Abstract Introduction Troponin T (cTnT) elevation is common in patients in the Intensive Care Unit (ICU) and associated with morbidity and mortality. Our aim was to determine the epidemiology of raised cTnT levels and contemporaneous electrocardiogram (ECG) changes suggesting myocardial infarction (MI) in ICU patients admitted for non-cardiac reasons. Methods cTnT and ECGs were recorded daily during week 1 and on alternate days during week 2 until discharge from ICU or death. ECGs were interpreted independently for the presence of ischaemic changes. Patients were classified into four groups: (i) definite MI (cTnT ≥15 ng/L and contemporaneous changes of MI on ECG), (ii) possible MI (cTnT ≥15 ng/L and contemporaneous ischaemic changes on ECG), (iii) troponin rise alone (cTnT ≥15 ng/L), or (iv) normal. Medical notes were screened independently by two ICU clinicians for evidence that the clinical teams had considered a cardiac event. Results Data from 144 patients were analysed (42% female; mean age 61.9 (SD 16.9)). A total of 121 patients (84%) had at least one cTnT level ≥15 ng/L. A total of 20 patients (14%) had a definite MI, 27% had a possible MI, 43% had a cTNT rise without contemporaneous ECG changes, and 16% had no cTNT rise. ICU, hospital and 180-day mortality was significantly higher in patients with a definite or possible MI. Only 20% of definite MIs were recognised by the clinical team. There was no significant difference in mortality between recognised and non-recognised events. At the time of cTNT rise, 100 patients (70%) were septic and 58% were on vasopressors. Patients who were septic when cTNT was elevated had an ICU mortality of 28% compared to 9% in patients without sepsis. ICU mortality of patients who were on vasopressors at the time of cTnT elevation was 37% compared to 1.7% in patients not on vasopressors. Conclusions The majority of critically ill patients (84%) had a cTnT rise and 41% met criteria for a possible or definite MI of whom only 20% were recognised clinically. Mortality up to 180 days was higher in patients with a cTnT rise.
Ostermann et al. (Fri,) conducted a cohort in Critical illness with non-cardiac diagnoses (n=144). Myocardial infarction (elevated troponin T ≥15 ng/L and contemporaneous ischemic ECG changes) vs. Normal troponin T (<15 ng/L) was evaluated on 180-day mortality (p=0.006). Among critically ill patients admitted for non-cardiac reasons, 41% met criteria for possible or definite myocardial infarction, which was associated with a 180-day mortality of 46% compared to 4% in patients with normal troponin.