Coronary artery disease in patients clinically diagnosed with myocardial infarction in the medical intensive care unit

Ko, Yousang; Park, Chi-Min; Kim, Wooyoul; Jeong, Byeong‐Ho; Suh, Gee Young; Lim, So Yeon; Kwon, O Jung; Jeon, Kyeongman

doi:10.1016/j.jcrc.2013.01.001

Cited by 6 publications

(9 citation statements)

References 27 publications

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“…from thrombus or acute antherosclerotic plaque rupture). Ko et al found only 30% of ICU patients with a clinical diagnosis of myocardial infarction ended up with a diagnosis of significant CAD on coronary angiography [1]. Our study findings support this sentiment with neither conventional segmental myocardial thickening analysis on 2D echo images nor longitudinal strain analysis by STE able to distinguish significant CAD presence either.…”

Section: Discussionsupporting

confidence: 69%

“…Significant coronary artery disease (CAD) and acute coronary artery occlusion can be challenging to diagnose in the critically ill [1]. Accurate diagnosis is important as unnecessary angiographic intervention or anti-thrombotic therapy can be harmful, particularly in those with multi-organ dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…Medical history, examination, ECG analysis, echo, and other investigations are all important for diagnosis but can lack precision in the ICU. Troponin levels, in particular, can be elevated in critically ill patients reflecting myocardial damage, but this may occur through several mechanisms other than significant CAD and/or acute atherosclerotic plaque disruption [1].…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of myocardial perfusion assessment with contrast echocardiography: can it improve recognition of significant coronary artery disease in the ICU?

et al. 2019

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Background Diagnosis of significant coronary artery disease (CAD) and acute coronary artery occlusion in ICU can be difficult, and an inappropriate intervention is potentially harmful. Myocardial contrast perfusion echo (MCPE) examines ultrasound contrast intensity replenishment curves in individual myocardial segments measuring peak contrast intensity and slope of return as an index of myocardial blood flow (units = intensity of ultrasound per second [dB/s]). MCPE could possibly serve as a triage tool to invasive angiography by estimating blood flow in the myocardium. We sought to assess feasibility in the critically ill and if MCPE could add incremental value to the clinical acumen in predicting significant CAD. Methods This is a single-centre, prospective, observational study. Inclusion criteria were as follows: adult ICU patients with troponin I > 50 ng/L and cardiology referral being made for consideration of inpatient angiography. Exclusion criteria were as follows: poor echo windows (2 patients), known ischaemic heart disease, and contrast contraindications. Seven cardiologists and 6 intensivists blinded to outcome assessed medical history, ECG, troponin, and 2D echo images to estimate likelihood of significant CAD needing intervention (clinical acumen). Clinical acumen, quantitative MCPE, and subjective (visual) MCPE were assessed to predict significant CAD. Results Forty patients underwent MCPE analysis, 6 (15%) had significant CAD, and median 11 of 16 segments (IQR 8–13) could be imaged (68.8% [IQR 50–81]). No adverse events occurred. A significant difference was found in overall MCPE blood flow estimation between those diagnosed with significant CAD and those without (3.3 vs 2.4 dB/s, p = 0.050). A MCPE value of 2.8 dB/s had 67% sensitivity and 88% specificity in detecting significant CAD. Clinical acumen showed no association in prediction of CAD (OR 0.6, p = 0.09); however, if quantitative or visual MCPE analysis was included, a significant association occurred (OR 17.1, p = 0.01; OR 23.0, p = 0.01 respectively). Conclusions MCPE is feasible in the critically ill and shows better association with predicting significant CAD vs clinical acumen alone. MCPE adds incremental value to initial assessment of the presence of significant CAD which may help guide those who require urgent angiography.

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of myocardial perfusion assessment with contrast echocardiography: can it improve recognition of significant coronary artery disease in the ICU?

et al. 2019

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“…Other studies conducted at this medical center have compared CAD and non-CAD patients, confirmed by coronary angiography in the medical ICU with suspected myocardial infarction [19]. This study found that male sex and focal hyperkinesia on echocardiography were independently associated with CAD.…”

Section: Discussionmentioning

confidence: 60%

Clinical Significance of Early Postoperative Elevated Cardiac Troponin-I Concentration in Non-cardiac Surgical Patients

Lim¹,

Park²,

Lee³

2014

Journal of Acute Care Surgery

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Purpose: Even in postoperative patients, cardiac troponin-I (cTnI) concentration can increase for a number of reasons. Identifying whether an increase is caused by clinically important postoperative complication such as acute myocardial infarction or by some other factor is thus of paramount importance. This study examined the cause of elevated concentration of cTnI during the early postoperative period, and compared the clinical features between patients with elevated cTnI concentration brought on by coronary artery disease (CAD) compared with those having a non-CAD cause. Methods: Postoperative cTnI concentration was measured in 3,878 patients during 30 months. We selected those patients, 155 in all, whose cTnI concentration exceeded normal value (0.78 ng/ml) more than once within seven days after surgery. The study was conducted with data collected retrospectively. We categorized patients into CAD and non-CAD group. Results: Of the 155 study subjects, 31 patients were in the CAD group and 124 were in the non-CAD group. The mean age of patients in CAD group (69.6±9.3) was older than that of non-CAD (63.6±13.9). The median value of peak cTnI concentration was higher in the CAD group. In the non-CAD group, 22 patients (17.7%) expired. Death occurred due to sepsis (21.6%), hypovolemic shock (38.1%) and arrhythmia (50%) in study subjects with elevated cTnI. There was one death in the CAD group. Conclusion: The patients with elevated postoperative cTnI concentration showed higher 28 day-mortality than those without elevation, especially in those without CAD. (J Acute Care Surg 2014;4:58-66)

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“…Three of the papers in this category [29][30][31] identified that the greater the increase in the serum cTn, the more likely there were to be echocardiographic abnormalities detected.…”

Section: Papers Considering the Use Of Echocardiography Or Angiographmentioning

confidence: 99%

Myocardial infarction in intensive care units: A systematic review of diagnosis and treatment

Carroll

Mount²,

Atkinson³

2016

Journal of the Intensive Care Society

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Regular 12 lead ECG or 12 lead ECG monitoring is more sensitive than 2 lead monitoring, regular measurement of cardiac enzymes is more sensitive than when provoked by symptoms. Coronary angiography rarely identifies treatable lesions, without regional wall motion abnormality on echocardiography. Evidence relating to treatment was limited. A potential strategy to diagnose myocardial infarctions in the ICU is proposed.

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Coronary artery disease in patients clinically diagnosed with myocardial infarction in the medical intensive care unit

Cited by 6 publications

References 27 publications

Feasibility of myocardial perfusion assessment with contrast echocardiography: can it improve recognition of significant coronary artery disease in the ICU?

Feasibility of myocardial perfusion assessment with contrast echocardiography: can it improve recognition of significant coronary artery disease in the ICU?

Clinical Significance of Early Postoperative Elevated Cardiac Troponin-I Concentration in Non-cardiac Surgical Patients

Myocardial infarction in intensive care units: A systematic review of diagnosis and treatment

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