Detecting myocardial infarction in critical illness using screening troponin measurements and ECG recordings

• DOI: 10.1186/cc6815
• Publication Date: 2008-03-05T07:13:25Z
• Authors: Wendy Lim; Paula Holinski; PJ Devereaux; Andrea Tkaczyk; Ellen McDonald; France Clarke; Ismael Qushmaq; Irene Terrenato; Holger Schunemann; Mark Crowther; Deborah Cook
• Keywords: Male; Research; Critical Illness; Myocardial Infarction; Middle Aged; Critical Care and Intensive Care Medicine; Troponin; 3. Good health; Electrocardiography; Intensive Care Units; 03 medical and health sciences; Outcome and Process Assessment, Health Care; 0302 clinical medicine; Humans; Regression Analysis; Female; Hospital Mortality; APACHE; Aged

To use screening cardiac troponin (cTn) measurements and electrocardiograms (ECGs) to determine the incidence of elevated cTn myocardial infarction (MI) in patients admitted intensive care unit (ICU), assess whether these findings influence prognosis. This is a prospective study. We enrolled consecutive general medical-surgical ICU over two months. All underwent systematic with ECGs on admission, then daily for first week ICU, alternate days up one month weekly thereafter until death or discharge, maximum Patients without investigations ordered during routine clinical study purposes but results were unavailable team. After study, all interpreted independently duplicate ischaemic changes meeting ESC/ACC criteria supporting diagnosis MI. classified as having MI (elevated ECG evidence MI), only (no no elevation. One hundred three 112 occasions. Overall, 37 (35.9 per cent) had an MI, 15 (14.6 51 (49.5 longer duration mechanical ventilation (p < 0.0001), stay = 0.001), higher mortality 0.0001) hospital compared those 0.001) than Elevated was associated increased (odds ratio 27.3, 95 cent CI 1.7 – 449.4), after adjusting APACHE II score, advanced life support. The team diagnosed 18 (17.5 grounds; four did not have by adjudication. Thus, detected additional 23 MIs practice, reflecting 62.2 ultimately diagnosed. similar outcomes alone. Systematic more found practice. independent predictor mortality. Further research needed evaluate subsequent treatment reduces