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.
Key IndexingTerms
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of the Medical SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Critical care medicine in the United States 1985–-2000: an analysis of bed numbers, use, and costs.Crit Care Med. 2004; 32: 1254-1259
- Elevated cardiac troponin measurements in critically ill patients.Arch Intern Med. 2006; 166: 2446-2454
- Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes.J Am Coll Cardiol. 2003; 41: 2004-2009
- Fourth universal definition of myocardial infarction (2018).J Am Coll Cardiol. 2018; 72: 2231-2264
- Prognostic value of troponins in acute pulmonary embolism.Circulation. 2007; 116: 427-433
- Serial measurements of troponin and echocardiography in patients with moderate-to-severe acute respiratory distress syndrome.J Crit Care. 2016; 33: 132-136
- 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
- Preoperative cardiac assessment in patients undergoing major vascular surgery.Vascular. 2011; 19: 178-186
- Clinical impact of routine cardiology consultation prior to elective carotid endarterectomy in neurologically asymptomatic patients.Eur J Vasc Endovasc Surgery. 2019;
- Hazards with ordering troponin in patients with low pretest probability of acute coronary syndrome.Am J Emerg Med. 2015; 33: 1258-1260
- Troponin testing in patients without chest pain or electrocardiographic ischemic changes.Am J Med. 2017; 130: 1205-1210
- Associations between cardiac troponin, mortality and subsequent use of cardiovascular services: differences in sex and ethnicity.Open Heart. 2018; 5e000713
- 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
Article info
Publication history
Published online: September 07, 2020
Accepted:
September 3,
2020
Received:
April 16,
2020
Footnotes
Conflict of Interest: None.
Source of Funding: None.
Identification
Copyright
© 2020 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
