PURPOSE: Detection of elevated blood levels of troponin indicates damage to myocardial cells, but does not indicate the mechanism. Causes other than acute coronary syndromes can result in troponin elevation and these conditions frequently occur in critically ill patients. Even though the current consensus definition of MI includes these patients with oxygen demand -supply mismatch into Type 2 MI, significant number of patients do not have typical symptoms, EKG changes or wall motion abnormalities.
METHODS: All patients admitted to medical intensive care unit with elevated troponins were categorized into 2 groups. Group 1- Patients with typical symptoms, new EKG changes or wall motion abnormalities (Type 2 MI). Group 2 - Patients without typical symptoms, EKG changes or wall motion abnormalities (Type X MI). Treatment initiated for elevated troponins in both groups and their final outcomes were reviewed. All patients with Type 1 MI were admitted to cardiac intensive care unit.
RESULTS: 131/223 (58.7%) of patients admitted to ICU between June 2009 to September 2009 had elevated troponins. 31/131 (23.7 %) of patients were classified into Type 2 MI and 100/131 (76.3 %) into Type X MI. 24/31 (77.5%) of Type 2 MI and 54/100(54%) of Type X MI patients were treated with at least one of the 5 agents (Aspirin, Plavix, Heparin, Statin, betablocker).
CONCLUSION: Significant number of patients admitted to ICU with elevated troponins do not have typical symptoms, EKG changes or wall motion abnormalities. When not contraindicated most of these patients are treated with conventional agents approved for treating acute coronary syndromes.
CLINICAL IMPLICATIONS: Identification and classification of patients admitted to the ICU with elevated troponins is important in prognosticating and treatment selections. Most of the currently available treatments for MI were extensively tested in Type 1 MI. Their role in other types of MI needs to be further studied.
DISCLOSURE: Prashant Gundre, No Financial Disclosure Information; No Product/Research Disclosure Information