Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, 2nd Floor Anaesthetics Corridor, Royal Infirmary Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
Intensive Care Med. 2018 Dec;44(12):2059-2069. doi: 10.1007/s00134-018-5425-0. Epub 2018 Oct 29.
To establish the incidence of myocardial infarction (MI) in ICU patients with co-existing cardiovascular disease (CVD), and explore its association with long-term survival.
In a multi-centre prospective cohort study in 11 UK ICUs, we enrolled 273 critically ill patients with co-existing CVD. We measured troponin I (cTnI) with a high sensitivity assay for 10 days; ECGs were carried out daily for 5 days and analysed by blinded cardiologists for dynamic changes. Data were combined to diagnose myocardial 'infarction', 'injury' or 'no injury' according to the third universal definition of MI. Patients were followed-up for 6 months. Regression and mediation analyses were used to explore relationships between acute physiological derangements, MI, and mortality.
cTnI was detected in all patients, with a rise/fall pattern consistent with an acute hit. In 73% of patients, this peaked on days 1-3 [median 114 ng/l (first, third quartiles: 27, 393)]. Serial ECGs indicated 24.2% (n = 66) of patients experienced MI, but > 95% were unrecognized by clinical teams. Type 2 MI was the most likely aetiology in all cases. A further 46.1% (n = 126) experienced injury (no ECG changes). Injury and MI were both associated with 6-month mortality (reference: no injury): OR injury 2.28 (95% CI 1.06-4.92, p = 0.035), OR MI 2.70 (95% CI 1.11-6.55, p = 0.028). Mediation analysis suggested MI partially mediated the relationship between acute physiological derangement and 6-month mortality (p = 0.002), suggesting a possible causal association.
Undiagnosed MI occurs in around a quarter of critically ill patients with co-existing CVD and is associated with lower long-term survival.
确定合并心血管疾病（CVD）的 ICU 患者心肌梗死（MI）的发生率，并探讨其与长期生存的关系。
在英国 11 家 ICU 的一项多中心前瞻性队列研究中，我们纳入了 273 名合并 CVD 的危重病患者。我们使用高敏检测法检测肌钙蛋白 I（cTnI），连续 10 天检测；心电图每天进行 5 天，并由盲法心脏病专家进行分析，以检测动态变化。根据第三次 MI 通用定义，将数据结合起来诊断心肌“梗死”、“损伤”或“无损伤”。患者随访 6 个月。回归和中介分析用于探讨急性生理紊乱、MI 和死亡率之间的关系。
所有患者均检测到 cTnI，升高/下降模式与急性打击一致。在 73%的患者中，该值在第 1-3 天达到峰值[中位数 114ng/l（第一、第三四分位数：27、393）]。连续心电图显示 24.2%（n=66）的患者发生 MI，但超过 95%的患者未被临床团队识别。在所有情况下，2 型 MI 最有可能是病因。另外 46.1%（n=126）的患者出现损伤（无心电图变化）。损伤和 MI 均与 6 个月死亡率相关（参考：无损伤）：损伤 OR 2.28（95%CI 1.06-4.92，p=0.035），MI OR 2.70（95%CI 1.11-6.55，p=0.028）。中介分析表明 MI 部分介导了急性生理紊乱与 6 个月死亡率之间的关系（p=0.002），表明可能存在因果关系。
合并 CVD 的 ICU 患者中约有四分之一发生未诊断的 MI，与长期生存率较低有关。
