Frequency and outcomes associated with myocardial ischemic burden in critically ill adults hospitalized with noncardiac conditions.

摘要

Critically ill adults may have occult coronary artery disease (CAD) or significant risk factors for CAD, placing them at risk for the development of cardiac complications even when admitted to intensive care units (ICU) for noncardiac reasons. This study was designed to determine whether: (a) acuity of illness (measured by APACHE II) influenced the frequency and outcomes of myocardial ischemic burden (MIB), detected by 12 lead electrocardiography and (b) the development of MIB in noncardiac patients was associated with cardiac complications.; The sample included 76 ICU patients admitted for noncardiac reasons. Patients were monitored up to 48 hours and data were collected to calculate demographics, APACHE II scores, cardiac complications and length of stay for ICU and hospital. Serum cardiac troponin I levels (cTnI) were measured 8–12 hours after the conclusion of the monitoring period. Data were analyzed using descriptive, correlational and multiple regression statistics.; The mean age of patients was 66 and the sample was 54% males. The mean APACHE II score was 14.8. Eight patients in the study (10.5%) developed myocardial ischemic events, 6 of whom also developed elevated cTnI levels consistent with myocardial injury. An additional 6 patients, for a total of 12 of 76 (15.8%) developed elevated cTnI levels. In the 8 patients with MIB, 37 transient ischemic events were detected with 95% of episodes silent.; The most significant correlations were between cardiac complications and the following variables: MIB, cTnI and advanced age (r = .58, p 0.01; r = .36, p 0.01; and r = .35, p 0.05, respectively). APACHE II, MIB, cTnI and age were evaluated by multiple regression, and all variables except APACHE II were found to predict cardiac complications ( R2 = .39, p 0.05). MIB contributed the majority of the influence in this equation.; The development of MIB is associated with worse cardiac outcomes and the presence of advanced age, MIB and elevated cTnI predict worse cardiac outcomes in critically ill patients admitted for noncardiac reasons. The use of 12 lead ST segment monitoring is recommended since most myocardial ischemia is silent.