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

Carroll, Iain; Mount, Thomas; Atkinson, D.

doi:10.1177/1751143716656642

Cited by 10 publications

(11 citation statements)

References 42 publications

(68 reference statements)

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“…When in doubt, attending physicians chose to exclude these patients. For future research, we advise clear definitions of cardiovascular events and no exclusion in the absence of a clear diagnosis by using 12-lead ECGs, repeated measurements of troponins, echocardiography to identify regional wall movement abnormalities and eventually angiography [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

The safety and efficacy of nicotine replacement therapy in the intensive care unit: a randomised controlled pilot study

Jong

Schuppers

Kruisdijk-Gerritsen

et al. 2018

Ann. Intensive Care

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BackgroundStudies evaluating nicotine replacement therapy (NRT) to prevent nicotine withdrawal symptoms in ICU patients have yielded conflicting results. We performed a randomised controlled double-blind pilot study to assess the safety and efficacy of NRT in critically ill patients. Mechanically ventilated patients admitted to two medical–surgical intensive care units and smoking more than 10 cigarettes per day before ICU admission were enrolled in this study. Participants were randomised to transdermal NRT (14 or 21 mg per day) or placebo until ICU discharge or day 30. Smoking status was confirmed by the biomarkers serum cotinine and urinary NNAL. The primary endpoint was 30-day mortality. Among secondary endpoints and post hoc endpoints, 90-day mortality, safety, time spent without delirium, sedation and coma, and patient destination at day 30 were addressed.ResultsWe enrolled 47 patients. No differences were found between NRT and control group patients concerning 30-day mortality (9.5 vs. 7.7%, p = 0.84) and 90-day mortality (14.3 vs. 19.2%, p = 0.67). The number of serious adverse events was comparable between groups (NRT: 4, control: 11, p = 0.13). At day 20, average time alive without delirium, sedation and coma was 16.6 days among NRT patients versus 12.6 days among control patients (p = 0.03). At day 30, more NRT group patients were discharged from the ICU or hospital compared with controls (p = 0.03).ConclusionsNRT did not affect mortality or the number of (serious) adverse events compared with placebo. Time alive without delirium, sedation and coma at day 20 in NRT patients was longer than in control patients. An adequately powered randomised controlled trial to further study safety and efficacy of NRT in ICU patients seems feasible and is warranted.Trial registration ClinicalTrials.gov, number NCT01362959, registered 1 June 2011Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0399-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The safety and efficacy of nicotine replacement therapy in the intensive care unit: a randomised controlled pilot study

Jong

Schuppers

Kruisdijk-Gerritsen

et al. 2018

Ann. Intensive Care

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“…In contrast to previous studies, our results were available to the medical team all the time, but specific therapeutic interventions upon the diagnosis of MI were applied only in half of all patients -they received antiplatelet or antiischemic treatment and two also underwent angiography. It remains unclear whether traditional antiplatelet, anti-ischemic or interventional treatments are appropriate or beneficial in treating MI in the ICU [3]. To date, there have been no randomised trials in this field and there are currently no guidelines regarding the management of MI in the ICU.…”

Section: F I G U R E 1 Roc Curve Of Maximal High Sensitive Troponin T (Hstnt) Predicting Icu-mortaliymentioning

confidence: 99%

“…Retrospective analyses by Poe et al [36] showed that patients with high cTn levels had lower 30-day mortality if treated with beta-blockers or aspirin than those who were not. However, the potential for iatrogenic harm from treatment presents a challenge for the physician to decide on a plan of action; recent surgery or coagulation disorders may limit the use of antiplatelets, and cardiovascular instability may preclude the use of betablockers and nitrates [2,3]. Moreover, in the setting of demand ischemia, it may be more appropriate to try to control physiologic variables -tachycardia, hypotension, anaemia.…”

Section: F I G U R E 1 Roc Curve Of Maximal High Sensitive Troponin T (Hstnt) Predicting Icu-mortaliymentioning

confidence: 99%

“…The heart is affected by intrinsic and extrinsic sympathetic stimulation, various other toxic mediators and stressors -anaemia, tachycardia, hypotension. MI in the critically ill may not always be apparent, and establishing a diagnosis is challenging [3]. Patient communication is limited and ischemic symptoms are often absent.…”

Section: Introductionmentioning

confidence: 99%

“…Patient communication is limited and ischemic symptoms are often absent. ECG changes may not be detected or are non-specific, and elevated cTn levels, although common, are difficult to interpret in the context of critical illness and other comorbidities [3][4][5][6]. Echocardiography and coronary angiography are not routinely performed in all patients with suspected MI.…”

Section: Introductionmentioning

confidence: 99%

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Importance of myocardial ischemia detected with protocol-based measurements of high-sensitivity troponin, ECG and echocardiography in critically ill patients without acute coronary syndrome—a prospective study

2021

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Elevated cardiac troponin is detected in the majority of critically ill patients. This study aimed to evaluate the prognostic value of protocol-guided detection of myocardial ischemia (MI) (serial 12-lead electrocardiograms (ECG), high-sensitivity troponin T (hsTnT) measurements, and echocardiography) and compare it with a retrospective cohort with only clinically driven detection of MI. In a prospective observational study, 95 patients hospitalized ≥48 hours for reasons other than acute coronary syndrome in medical or surgical intensive-care unit (ICU) were enrolled. A protocol-based approach, with regular 12-lead ECG recordings, hsTnT measurements and admission echocardiography was conducted. All events possibly indicating MI were documented, and ECG, hsTnT, echocardiography were repeated. The protocol-based approach was compared to a retrospective group with only clinically driven detection of MI. In the prospective group, 95.8% of patients had at least one elevated hsTnT value. A hsTnT ＞70 ng/L was associated with the use of inotropes (OR 3.35 (95% CI: 1.184, 9.472), p = 0.022), left ventricular ejection fraction <30% (OR 9.65 (95% CI: 1.172, 76.620), p = 0.035), regional wall motion abnormalities (OR 3.87 (95% CI: 1.032, 14.533), p = 0.045), ICU mortality (OR 8.38 (95% CI: 1.004, 69.924), p = 0.0495), hospital mortality (OR 3.05 (95% CI: 1.133, 8.230), p = 0.027) and 1-year mortality (OR: 5.43 (95% CI: 2.1099, 13.971), p = 0.005). The incidence of MI was higher in the prospective, as compared to the retrospective group (22.1% vs 5.3%; p = 0.001). MI, compared to the high “hsTnT positive only” group, predicted hospital mortality (OR 3.33 (95% CI: 1.190, 9.329), p = 0.02) and 1-year mortality (OR 4.66 (95% CI: 1.647, 13.222), p = 0.0037). A protocol-based compared to a clinically driven approach for the detection of MI reveals more patients with MI. The majority of critically ill patients have elevated hsTnT levels. Detected MI additionally stratifies patients with elevated hsTnT to higher hospital and 1-year mortality.

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Assessment of Oxygen Supply-Demand Imbalance and Outcomes Among Patients With Type 2 Myocardial Infarction

et al. 2022

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Key Points Question What are the clinical outcomes of the different factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction? Findings In this secondary analysis of a randomized clinical trial, tachyarrhythmia was the most common factor associated with oxygen supply-demand imbalance, occurring in 55% of all patients with type 2 myocardial infarction, and was associated with better outcomes. Systemic illnesses associated with type 2 myocardial infarction, which presented with anemia, hypoxemia, hypotension, or severe hypertension, were less common, but patients with these illnesses shared similar characteristics and had the highest rates of all-cause death. Meaning The underlying factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction may provide useful prognostic information.

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

Cited by 10 publications

References 42 publications

The safety and efficacy of nicotine replacement therapy in the intensive care unit: a randomised controlled pilot study

The safety and efficacy of nicotine replacement therapy in the intensive care unit: a randomised controlled pilot study

Importance of myocardial ischemia detected with protocol-based measurements of high-sensitivity troponin, ECG and echocardiography in critically ill patients without acute coronary syndrome—a prospective study

Assessment of Oxygen Supply-Demand Imbalance and Outcomes Among Patients With Type 2 Myocardial Infarction

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