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Troponin in critical care patients and outcomes

Elizabeth M Cole1, Annemarie B Docherty2

  • 1Department of Anaesthesia, NHS Lothian, Edinburgh, UK.

British Journal of Hospital Medicine (London, England : 2005)
|May 30, 2020
PubMed

Insights

Critically ill patients with cardiovascular disease often experience unrecognized myocardial infarction, leading to higher mortality. Early identification and management of oxygen supply-demand imbalance can improve outcomes.

Area of Science:

  • Critical Care Medicine
  • Cardiology
  • Biomarkers

Background:

  • Myocardial infarction (MI) is a frequent complication in critically unwell patients, particularly those with pre-existing cardiovascular disease.
  • MI in this population is linked to significantly increased overall mortality.
  • A substantial number of intensive care unit (ICU) patients with acute MI remain undiagnosed.

Purpose of the Study:

  • To explore current guidelines for diagnosing myocardial infarction in critically ill patients.
  • To review research on the utility of troponin as a diagnostic and prognostic marker.
  • To highlight the potential for improved patient outcomes through risk identification and care modification.

Main Methods:

  • Review of existing clinical guidelines for MI diagnosis.
  • Analysis of research studies investigating troponin's role in diagnosis and prognosis.
  • Discussion of the pathophysiology of MI in the critically unwell, focusing on oxygen supply-demand imbalance.

Main Results:

  • The majority of acute myocardial infarctions in the ICU setting are currently unrecognized.
  • Oxygen supply-demand imbalance is the predominant underlying cause of MI in this cohort.
  • Troponin assays are valuable diagnostic and prognostic tools.

Conclusions:

  • Improved recognition of myocardial infarction in critically ill patients is crucial.
  • Addressing oxygen supply-demand imbalance offers a potential strategy to reduce mortality.
  • Utilizing troponin effectively can aid in both diagnosis and prognosis, leading to better patient management.

Keywords:
Cardiovascular diseaseCritical careMortalityTroponin

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