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Myocardial Injury Is Associated with the Incidence of Major Adverse Cardiac Events in Patients with Severe Trauma
Alexandra Stroda1, Carina Jaekel2, René M'Pembele1
1Department of Anesthesiology, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Dusseldorf, Germany.
Insights
Myocardial injury in severe trauma patients is linked to higher risks of major adverse cardiac events (MACE) and acute kidney injury (AKI). This study highlights the importance of assessing cardiac health following trauma.
Area of Science:
- Cardiology
- Trauma Medicine
- Critical Care
Background:
- Severe trauma can lead to end-organ damage, including myocardial injury.
- Myocardial injury in trauma patients is associated with increased mortality.
- The link between myocardial injury and in-hospital major adverse cardiac events (MACE) in trauma patients is not well-established.
Purpose of the Study:
- To investigate the association between myocardial injury at presentation and the incidence of in-hospital MACE in severe trauma patients.
- To determine the association between myocardial injury and the incidence of acute kidney injury (AKI) within 72 hours.
Main Methods:
- Retrospective cohort study of adult severe trauma patients (January 2016 - December 2019).
- Primary exposure: myocardial injury at presentation.
- Outcomes: in-hospital MACE and AKI within 72 hours.
- Statistical analysis included receiver operating characteristic (ROC) curve analysis for hsTnT discrimination and multivariate logistic regression.
Main Results:
- 353 patients included; 72.5% male, mean age 55 years.
- Area under the curve (AUC) for hsTnT predicting MACE was 0.68; for AKI, it was 0.64.
- Myocardial injury was independently associated with MACE (adjusted OR 2.97) and AKI (adjusted OR 2.14).
Conclusions:
- Myocardial injury at presentation in severe trauma patients is an independent predictor of in-hospital MACE.
- Myocardial injury is also independently associated with the incidence of AKI in this patient population.
Background:
Severe trauma potentially results in end-organ damage such as myocardial injury. Data suggest that myocardial injury is associated with increased mortality in this cohort, but the association with the incidence of in-hospital major adverse cardiac events (MACE) remains undetermined.
Methods:
Retrospective cohort study including adult patients with severe trauma treated at the University Hospital Duesseldorf between January 2016 and December 2019. The main exposure was myocardial injury at presentation. Endpoints were in-hospital incidence of MACE and incidence of acute kidney injury (AKI) within 72 h. Discrimination of hsTnT for MACE and AKI was examined by the receiver operating characteristic curve (ROC) and the area under the curve (AUC). We conducted multivariate logistic regression analysis.
Results:
We included 353 patients in our final analysis (72.5% male (256/353), age: 55 ± 21 years). The AUC for hsTnT and MACE was 0.68 [95% confidence interval (CI): 0.59-0.78]. The AUC for hsTnT and AKI was 0.64 [95% (CI): 0.55-0.72]. The adjusted odds ratio (OR) for myocardial injury and MACE was 2.97 [95% (CI): 1.31-6.72], and it was 2.14 [95% (CI): 1.03-4.46] for myocardial injury and AKI.
Conclusion:
Myocardial injury at presentation in patients with severe trauma is independently associated with the incidence of in-hospital MACE and AKI.
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