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The Impact of Cardiology Consultation on Medical Intensive Care Unit Patients with Elevated Troponin Levels

Published:September 07, 2020DOI:https://doi.org/10.1016/j.amjms.2020.09.005

      Abstract

      Background

      Cardiac troponin (cTn) is mainly used to diagnose acute coronary syndrome (ACS). However, cTn can also be elevated in critically ill patients secondary to demand ischemia or myocardial injury. The impact of cardiology consultation on the clinical outcomes of patients admitted to medical intensive care unit (ICU) with elevated cTn is unclear.

      Methods

      A retrospective analysis of medical ICU patients with elevated cTn without evidence of ACS between January 2013 through December 2018. Patients were stratified based on documentation of cardiology consultation. The primary outcome was 1-year mortality. Secondary outcomes were in-hospital and 30-day mortality, the length of stay (LOS), further cardiac testing, 30-day readmission rate, new prescription of cardiac medications, and the predictors of a cardiology consultation.

      Results

      Of 846 patients screened, 766 patients were included, of whom 63.2% had cardiology consultation. Cardiology consultation group had longer median LOS (7 vs. 5 days, P = 0.007), additional cardiac testing (90.3% vs. 67.7%, P < 0.001), and more new cardiac medications (52.1% vs. 16.3%, P < 0.001). No difference was noted in-hospital mortality (adjusted odds ratio [aOR], 0.6, 95% CI, 0.4–1.1, P = .117), 30-day mortality (aOR = 0.8, 95% CI, 0.5–1.4, P = .425), 1- year mortality (aOR, 1.4, 95% CI, 0.9–2.2, P = .193), or cardiac-specific 30-day readmission rate (aOR, 7.0, 95% CI, 0.7–14.9, P = .137). History of coronary artery disease (CAD) was the most independent predictor for a cardiology consult (aOR, 2.2, 95% CI, 1.3–3.8, P < .001).

      Conclusion

      Cardiology consultation for elevated cTn in medical ICU patients was associated with increased cardiac testing and LOS, without significant impact on mortality.

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      References

        • Halpern NA
        • Pastores SM
        • Greenstein RJ
        Critical care medicine in the United States 1985–-2000: an analysis of bed numbers, use, and costs.
        Crit Care Med. 2004; 32: 1254-1259
        • Lim W
        • Qushmaq I
        • Devereaux PJ
        • Heels-Ansdell D
        • Lauzier F
        • Ismaila AS
        • et al.
        Elevated cardiac troponin measurements in critically ill patients.
        Arch Intern Med. 2006; 166: 2446-2454
        • Ammann P
        • Maggiorini M
        • Bertel O
        • Haenseler E
        • Joller-Jemelka HI
        • Oechslin E
        • et al.
        Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes.
        J Am Coll Cardiol. 2003; 41: 2004-2009
        • Thygesen K
        • Alpert JS
        • Jaffe AS
        • Chaitman BR
        • Bax JJ
        • Morrow DA
        • et al.
        Fourth universal definition of myocardial infarction (2018).
        J Am Coll Cardiol. 2018; 72: 2231-2264
        • Becattini C
        • Vedovati MC
        • Agnelli G
        Prognostic value of troponins in acute pulmonary embolism.
        Circulation. 2007; 116: 427-433
        • Lazzeri C
        • Bonizzoli M
        • Cozzolino M
        • Verdi C
        • Cianchi G
        • Batacchi S
        • et al.
        Serial measurements of troponin and echocardiography in patients with moderate-to-severe acute respiratory distress syndrome.
        J Crit Care. 2016; 33: 132-136
        • Ostermann M
        • Lo J
        • Toolan M
        • Tuddenham E
        • Sanderson B
        • Lei K
        • et al.
        A prospective study of the impact of serial troponin measurements on the diagnosis of myocardial infarction and hospital and six- month mortality in patients admitted to ICU with non-cardiac diagnoses.
        Critical care. 2014; 18: R62
        • Troisi N
        • Pulli R
        • Dorigo W
        • Lo Sapio P
        • Pratesi C
        Preoperative cardiac assessment in patients undergoing major vascular surgery.
        Vascular. 2011; 19: 178-186
        • Squizzato F
        • Antonello M
        • Taglialavoro J
        • Prosdocimi L
        • Grego F
        • Lupia M
        • et al.
        Clinical impact of routine cardiology consultation prior to elective carotid endarterectomy in neurologically asymptomatic patients.
        Eur J Vasc Endovasc Surgery. 2019;
        • Talebi S
        • Ferra RM
        • Tedla S
        • DeRobertis A
        • Garofoli AC
        • Visco F
        • et al.
        Hazards with ordering troponin in patients with low pretest probability of acute coronary syndrome.
        Am J Emerg Med. 2015; 33: 1258-1260
        • Shimoni Z
        • Arbuzov R
        • Froom P
        Troponin testing in patients without chest pain or electrocardiographic ischemic changes.
        Am J Med. 2017; 130: 1205-1210
        • Winchester DE
        • Kline K
        • Estel C
        • Mahtta D
        • Taasan S
        • Peacock FW
        Associations between cardiac troponin, mortality and subsequent use of cardiovascular services: differences in sex and ethnicity.
        Open Heart. 2018; 5e000713
        • Rothenberg FG
        • Clay MB
        • Jamali H
        • Vandivier-Pletsch RH
        Systematic review of β blocker, aspirin, and statin in critically ill patients: importance of severity of illness and cardiac troponin.
        J Investig Med. 2017; 65: 747-753