Document Detail


Electrocardiographic ST-segment elevation myocardial infarction in critically ill patients: an observational cohort analysis.
MedLine Citation:
PMID:  20890196     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the specificity of the electrocardiographic diagnosis of ST-segment elevation myocardial infarction in the critical care unit setting.
DESIGN: Retrospective observational cohort analysis.
SETTING: An 880-bed tertiary care teaching hospital with 120 intensive care unit beds.
PATIENTS: The population included medical, surgical, trauma, and neurosurgical intensive care unit patients.
INTERVENTIONS: Electrocardiograms were systematically collected to include all consecutive recordings over a 15-month period in which the interpretation software indicated ***ACUTE MI***. Patient demographics, markers of intensive care unit complexity, and hospital mortality were ascertained. The electrocardiograms were then further evaluated by a blinded, board-certified cardiologist for agreement or disagreement with the interpretation software. Serum troponin measurements obtained within 96 hrs of electrocardiogram acquisition were used to determine the likelihood of myocardial infarction.
MEASUREMENTS AND MAIN RESULTS: Over the 15-month study period, the interpretation software diagnosed ST-segment elevation myocardial infarction in 67 of 2243 intensive care unit patients (2.99%) who had an electrocardiogram performed. In the final study population of 46 cases with electrocardiographic ST-segment elevation myocardial infarction, 85% had peak troponin elevation<5 ng/mL, a strong suggestion against clinical ST-segment elevation myocardial infarction. The cardiologist agreed with the computer interpretation in 39% (18 of 46) of cases, but of those 18 patients, only six showed a significant rise in the troponin level. The cardiologist disagreed with the computer interpretation in 60.9% (28 of 46) of cases and of those, one patient had a marked elevation of the cardiac troponin.
CONCLUSIONS: ST-segment elevation myocardial infarction in the intensive care unit is a relatively common electrocardiographic reading both by standard interpretation software and by expert evaluation. In contrast to nonintensive care unit patients who present with chest pain, the electrocardiographic ST-segment elevation myocardial infarction diagnosis seems to be a nonspecific finding in the intensive care unit that is frequently the result of a variety of nonischemic processes. The vast majority of such patients do not have frank ST-segment elevation myocardial infarction.
Authors:
Stephen L Rennyson; Jody Hunt; Michael W Haley; H James Norton; Laszlo Littmann
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  38     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-22     Completed Date:  2010-12-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2304-9     Citation Subset:  AIM; IM    
Affiliation:
Medical College of Virginia, Richmond, VA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Biological Markers / blood
Chi-Square Distribution
Cohort Studies
Critical Illness
Echocardiography, Doppler / methods
Electrocardiography / methods*
Female
Follow-Up Studies
Hospitals, Teaching
Humans
Intensive Care / methods
Intensive Care Units
Male
Middle Aged
Monitoring, Physiologic / methods
Myocardial Infarction / blood*,  diagnosis*,  mortality
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index
Statistics, Nonparametric
Survival Rate
Troponin I / blood*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Troponin I
Comments/Corrections
Comment In:
Crit Care Med. 2010 Dec;38(12):2412-3   [PMID:  21088508 ]

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