Unrecognised myocardial infarction and its relationship to outcome in critically ill patients with cardiovascular disease

Abstract

Myocardial infarction and outcome in cardiovascular ICU patients Take-home message: Around a quarter of patients with pre-existing cardiovascular disease experience myocardial infarction (MI) during ICU care, which is usually unrecognized in routine care and results predominantly from oxygen supply-demand imbalance (type 2 MI). Both myocardial injury (isolated troponin elevation) and MI are associated with worse short and long-term survival, and MI may be on the causal pathway between acute physiological derangement and mortality.

Cardiovascular Risks Associated with Gender and Aging

“…Rates of diagnosed MI are also higher in men over 80 years as compared with women [6]. However, this data does not reflect the potential discrepancies related to diagnosis of acute coronary syndrome in women, including reported underdiagnoses and misdiagnosis of cardiac events in women, including in MI [22,23,24,25].…”

Red cell transfusions: Is less always best?

“…14 One quarter of ICU patients with underlying cardiovascular disease experience AMI, the majority of which are due to oxygen supply-demand imbalance. 15 Furthermore, in patients with myelodysplastic syndromes (MDS), many of whom are elderly and require regular transfusion support, anemia itself is an independent predictor of poorer cardiovascular outcomes such as cardiac failure, coronary artery disease, cardiac remodeling, cardiac arrhythmia, and overall cardiovascular mortality. 16 This is in contrast to acute trauma or bleeding-related anemia in otherwise fit patients with adequate cardiac reserve to appropriately compensate to lower Hb levels in the short-term.…”

“…Myocardial oxygen delivery is further impaired by atheromatous disease 14 . One quarter of ICU patients with underlying cardiovascular disease experience AMI, the majority of which are due to oxygen supply–demand imbalance 15 . Furthermore, in patients with myelodysplastic syndromes (MDS), many of whom are elderly and require regular transfusion support, anemia itself is an independent predictor of poorer cardiovascular outcomes such as cardiac failure, coronary artery disease, cardiac remodeling, cardiac arrhythmia, and overall cardiovascular mortality 16 .…”

Restrictive blood transfusion – is less really more?

“…As a result, the majority of ischaemic events in the peri‐operative period are often silent and missed clinically. A recent prospective, observational study in critically ill patients found that more than 95% of myocardial infarctions were undetected by clinical teams .…”