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A prospective study of the impact of serial troponin measurements on the diagnosis of myocardial infarction and hospital and six-month mortality in patients admitted to ICU with non-cardiac diagnoses.

Ostermann, M; Lo, J; Toolan, M; Tuddenham, E; Sanderson, B; Lei, K; Smith, J; Griffiths, A; Webb, I; Coutts, J; et al. Ostermann, M; Lo, J; Toolan, M; Tuddenham, E; Sanderson, B; Lei, K; Smith, J; Griffiths, A; Webb, I; Coutts, J; Chambers, J; Collinson, P; Peacock, J; Bennett, D; Treacher, D (2014) A prospective study of the impact of serial troponin measurements on the diagnosis of myocardial infarction and hospital and six-month mortality in patients admitted to ICU with non-cardiac diagnoses. Critical Care, 18 (R62). ISSN 1364-8535 https://doi.org/10.1186/cc13818
SGUL Authors: Collinson, Paul

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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. 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.

Item Type: Article
Additional Information: © 2014 Ostermann et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Science & Technology, Life Sciences & Biomedicine, Critical Care Medicine, General & Internal Medicine, CRITICALLY-ILL PATIENTS, INTENSIVE-CARE-UNIT, ELEVATED CARDIAC TROPONIN, ACUTE CORONARY SYNDROMES, RISK-FACTOR, ELECTROCARDIOGRAM INTERPRETATION, PROGNOSTIC-SIGNIFICANCE, SEPTIC SHOCK, SEPSIS, TERM, 11 Medical And Health Sciences
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: Critical Care
ISSN: 1364-8535
Language: eng
Dates:
DateEvent
4 April 2014Published
PubMed ID: 24708826
Web of Science ID: WOS:000339627400080
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/107252
Publisher's version: https://doi.org/10.1186/cc13818

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