PURPOSE: There are causes other than acute coronary syndromes (ACS) that can result in troponin elevation in critically ill patients. A significant number of these patients do not have typical anginal symptoms, ECG changes or wall motion abnormalities yet, are treated with conventional agents such as antiplatelets, beta blockers, statins etc. that are proven to be beneficial for ACS. Very little data exits on whether treatment with these agents would benefit such patients and the decision to use them is at the discretion of the treating intensivists.
METHODS: We conducted a nation wide survey among 310 intensivists regarding their treatment strategies for critically ill patients with elevated cardiac troponins and without typical symptoms of MI or ECG changes. The options provided included antiplatelet agents, anti-thrombotic agents, beta blockers, angiotensin converting enzyme inhibitors(ACEI) and angiogram.
RESULTS: 76% of intensivists said they would start either Aspirin or Clopidogrel, 47.4% would start either low molecular weight heparin or unfractionated heparin, 48.9% would start high dose statins, 68.7% would start beta-blockers, and 37.6% would use ACEI. Additionally 72.7% intensivists said they would request a cardiology consultation and 51.3% said they would refer these patients for angiogram once stable.
CONCLUSIONS: A wide variety of opinion exists among the intensivists regarding the treatment of critically ill patients with elevated troponins due to the lack of guidelines. Randomized controlled studies are needed to determine the role of these agents in such patients.
CLINICAL IMPLICATIONS: Research needs to be done to determine the optimum treatment for elevated troponins in cases not associated with acute coronary syndromes.
DISCLOSURE: The following authors have nothing to disclose: Prashanth Gundre, Michael Kleyn, Guy Kulbak, Yizhak Kupfer, Sidney Tessler
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