Detecting Heart Attacks in ICU Patients
Author Information
Author(s): Wendy Lim, Paula Holinski, PJ Devereaux, Andrea Tkaczyk, Ellen McDonald, France Clarke, Ismael Qushmaq, Irene Terrenato, Holger Schunemann, Mark Crowther, Deborah Cook
Primary Institution: McMaster University
Hypothesis
Can screening troponin measurements and ECG recordings determine the incidence of myocardial infarction in ICU patients and influence prognosis?
Conclusion
Systematic screening detected elevated troponin levels and myocardial infarction in more patients than routine clinical practice, with elevated troponin being an independent predictor of hospital mortality.
Supporting Evidence
- 37 patients (35.9%) had a myocardial infarction.
- Patients with elevated troponin had higher hospital mortality (26.7%) compared to those without cTn elevation.
- Screening detected 23 MIs that were missed by routine clinical diagnosis.
Takeaway
Doctors checked heart damage in ICU patients using special tests, and found more heart attacks than they usually do, which helps them understand who might be at risk.
Methodology
Consecutive patients admitted to the ICU were screened with troponin measurements and ECGs upon admission and regularly thereafter for up to two months.
Potential Biases
The ICU team was not aware of the screening results, which could influence clinical decisions.
Limitations
The study had a relatively small sample size and may not be applicable to other settings with different patient demographics.
Participant Demographics
Patients were primarily medical (63.1%) with a mean age of 64.1 years.
Statistical Information
P-Value
p<0.0001
Confidence Interval
95% CI 1.7 – 449.4
Statistical Significance
p<0.0001
Digital Object Identifier (DOI)
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