Department of Internal Medicine, Creighton University, Omaha, Nebraska.
Department of Internal Medicine, Creighton University, Omaha, Nebraska.
Am J Med Sci. 2021 Mar;361(3):303-309. doi: 10.1016/j.amjms.2020.09.005. Epub 2020 Sep 7.
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.
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.
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).
Cardiology consultation for elevated cTn in medical ICU patients was associated with increased cardiac testing and LOS, without significant impact on mortality.
心肌肌钙蛋白（cTn）主要用于诊断急性冠状动脉综合征（ACS）。然而，在因需求缺血或心肌损伤而病情危急的患者中，cTn 也可能升高。心脏病学咨询对因 cTn 升高而入住重症监护病房（ICU）的患者的临床结局的影响尚不清楚。
对 2013 年 1 月至 2018 年 12 月期间因无 ACS 证据而 cTn 升高的 ICU 患者进行回顾性分析。根据心脏病学咨询记录对患者进行分层。主要结局为 1 年死亡率。次要结局为院内和 30 天死亡率、住院时间（LOS）、进一步的心脏检查、30 天再入院率、新的心脏药物处方以及心脏病学咨询的预测因素。
在筛选出的 846 名患者中，纳入了 766 名患者，其中 63.2%的患者接受了心脏病学咨询。接受心脏病学咨询的患者 LOS 中位数更长（7 天 vs. 5 天，P=0.007），进一步的心脏检查更多（90.3% vs. 67.7%，P<0.001），新的心脏药物治疗更多（52.1% vs. 16.3%，P<0.001）。院内死亡率（调整后比值比[aOR]，0.6，95%置信区间[CI]，0.4-1.1，P=0.117）、30 天死亡率（aOR=0.8，95%CI，0.5-1.4，P=0.425）、1 年死亡率（aOR，1.4，95%CI，0.9-2.2，P=0.193）或心脏特异性 30 天再入院率（aOR，7.0，95%CI，0.7-14.9，P=0.137）无差异。冠状动脉疾病（CAD）病史是进行心脏病学咨询的最独立预测因素（aOR，2.2，95%CI，1.3-3.8，P<0.001）。
对因 cTn 升高而入住 ICU 的患者进行心脏病学咨询与增加心脏检查和 LOS 相关，但对死亡率无显著影响。
