Abstract
ObjectivesCritically ill patients have raised troponins. This study aimed to assess the incidence of myocardial injury in the intensive care unit (ICU) at a tertiary care hospital and assess the management and prognosis.MethodsThis retrospective study included adult patients who were admitted to the ICU of Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2019 and had undergone a high-sensitive cardiac troponin (hs-cTn) assay. Patients admitted with a primary diagnosis of myocardial infarction were excluded.ResultsA total of 264 patients had their hs-cTn measured during the study period. Of these, 128 (64.3 ± 17.1 years; 58.6% male) had elevated levels, giving an incidence rate of approximately 48.5%. Those with raised troponin were older and had more co-morbidities. These patients were also more critically ill with lower blood pressure, higher heart rates and increased hypotensive episodes. Of these, 47 were treated for acute coronary syndrome, 32 underwent coronary angiography and only three required stenting. Patients with raised troponin had a poor outcome with only 45 (35.2%) surviving to discharge compared to 101 (74.3%) with normal troponin. Patients with raised troponin had shorter hospital stays than those with normal troponin (16 versus 19 days; P = 0.017).ConclusionA high proportion of critically ill patients showed evidence of myocardial injury without significant coronary artery disease, which is associated with a poor prognosis. Further prospective studies are required to ascertain the best course of treatment for these patients.
Highlights
The use of high sensitive cardiac troponins has helped us identify many previously unrecognised patients with myocardial injury in a variety of clinical settings.1;2 It has made us aware that the heart, like any other organ, can be affected in systemic illnesses
This was a retrospective study involving adult patients admitted to the intensive care unit (ICU) of our institution between 1st January and 31st December 2019 who had a high sensitive cardiac troponin (Hs-CTn) assay performed
It is very specific to cardiac muscle, high sensitive cardiac troponins (hs-cTn) does not differentiate between the etiologically diverse types of myocardial infarction (MI) or non-MI related myocardial injury.2;3 The fourth universal definition of MI has accommodated these conditions of myocardial injury without infarction and lays down criteria to help differentiate between infarction and injury
Summary
The use of high sensitive cardiac troponins (hs-cTn) has helped us identify many previously unrecognised patients with myocardial injury in a variety of clinical settings.1;2 It has made us aware that the heart, like any other organ, can be affected in systemic illnesses. It is very specific to cardiac muscle, hs-cTn does not differentiate between the etiologically diverse types of myocardial infarction (MI) or non-MI related myocardial injury.2;3 The fourth universal definition of MI has accommodated these conditions of myocardial injury without infarction and lays down criteria to help differentiate between infarction and injury.. Type 1 MI is the subtype that we commonly associate with a “heart attack” or an atherothrombotic MI due to plaque rupture. Type 2 MI on the other hand is associated with a demand-supply mismatch and is commonly seen in critically ill patients in the intensive care unit (ICU) and in other severe systemic illnesses. The other types of MI are those occurring in special circumstances such as post angioplasty, post coronary artery bypass grafting or after a cardiac arrest
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
