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Open Access 01-06-2014 | Commentary

The diagnostic challenge of myocardial infarction in critically ill patients: do high-sensitivity troponin measurements add more clarity or more confusion?

Authors: Kada Klouche, Olivier Jonquet, Jean Paul Cristol

Published in: Critical Care | Issue 3/2014

Abstract

In ICU settings, the diagnosis and treatment of acute myocardial infarction (AMI) are challenging, partly because cardiac troponin increase occurs frequently. In the previous issue of Critical Care, Ostermann and colleagues reported that myocardial infarction (MI), screened by plasma troponin and electrocardiography changes, is common and often clinically unrecognized in the ICU. Although the clinical significance of underdiagnosed MIs remains unclear, this approach may help to target and further investigate the at-risk population for appropriate therapy.

Ostermann M, Lo J, Toolan M, Tuddenham E, Sanderson B, Lei K, Smith J, Griffiths A, Webb I, Coutts J, Chambers J, Collinson P, Peacok J, Bennett D, Treacher D: A prospective study of the impact of serial troponin measurements on the diagnosis of myocardial infarction and hospital and 6-month mortality in patients admitted to ICU with non-cardiac diagnoses. Crit Care 2014, 18: R62. 10.1186/cc13818PubMedPubMedCentralCrossRef

Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Thygesen K, Alpert JS, White HD, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Chaitman BA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, the writing group on behalf of the joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. Authors/Task force Members chair persons, et al.: Third universal definition of myocardial infarction. Eur Heart J 2012, 33: 2551-2567. 10.1093/eurheartj/ehs184PubMedCrossRef

Rennyson SL, Hunt J, Haley MW, Norton HJ, Littmann L: Electrocardiographic ST-segment elevation myocardial infarction in critically ill patients: an observational cohort analysis. Crit Care Med 2010, 38: 2304-2309. 10.1097/CCM.0b013e3181fa02cdPubMedCrossRef

Mehta S, Granton J, Lapinsky SE, Newton G, Bandayrel K, Little A, Siau C, Cook DJ, Ayers D, Singer J, Lee TC, Walley KR, Storms M, Cooper J, Holmes CL, Hebert P, Gordon AC, Presneill J, Russell JA, Vasopressin and Septic Shock Trial (VASST) Investigators: Agreement in electrocardiogram interpretation in patients with septic shock. Crit Care Med 2011, 39: 2080-2086. 10.1097/CCM.0b013e318222720ePubMedCrossRef

Lim W, Whitlock R, Khera V, Devereaux PJ, Tkaczyk A, Heels-Ansdell D, Jacka M, Cook D: Etiology of troponin elevation in critically ill patients. J Crit Care 2010, 25: 322-328. 10.1016/j.jcrc.2009.07.002PubMedCrossRef

Ammann P, Maggiorini M, Bertel O, Haenseler E, Joller-Jemelka HI, Oechslin E, Minder EI, Rickli H, Fehr T: Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes. J Am Coll Cardiol 2003, 41: 2004-2009. 10.1016/S0735-1097(03)00421-2PubMedCrossRef

Lim W, Holinski P, Devereaux PJ, Tkaczyk A, McDonald E, Clarke F, Qushmaq I, Terrenato I, Schunemann H, Crowther M, Cook D: Detecting myocardial infarction in critical illness using screening troponin measurements and ECG recordings. Crit Care 2008, 12: R36. 10.1186/cc6815PubMedPubMedCentralCrossRef

Landesberg G, Vesselov Y, Einav S, Goodman S, Sprung CL, Weissman C: Myocardial ischemia, cardiac troponin, and long-term survival of high-cardiac risk critically ill intensive care unit patients. Crit Care Med 2005, 33: 1281-1287. 10.1097/01.CCM.0000166607.22550.87PubMedCrossRef

Apple FS, Collinson PO: Analytical characteristics of high-sensitivity cardiac troponin assays. Clin Chem 2012, 58: 54-61. 10.1373/clinchem.2011.165795PubMedCrossRef

10.

Hammarsten O, Fu ML, Sigurjonsdottir R, Petzold M, Said L, Landin-Wilhelmsen K, Widgren B, Larsson M, Johanson P: Troponin T percentiles from a random population sample, emergency room patients and patients with myocardial infarction. Clin Chem 2012, 58: 628-637. 10.1373/clinchem.2011.171496PubMedCrossRef

11.

Korley FK, Jaffe AS: Preparing the United States for high-sensitivity cardiac troponin assays. J Am Coll Cardiol 2013, 61: 1753-1758. 10.1016/j.jacc.2012.09.069PubMedCrossRef

12.

Newby LK, Jesse RL, Babb JD, Christenson RH, De Fer TM, Diamond GA, Fesmire FM, Geraci SA, Gersh BJ, Larsen GC, Kaul S, McKay CR, Philippides GJ, Weintraub WS: ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation Task Force on clinical expert consensus documents. J Am Coll Cardiol 2012, 60: 2427-2463. 10.1016/j.jacc.2012.08.969PubMedCrossRef

13.

Kelley WE, Januzzi JL, Christenson RH: Increases of cardiac troponin in conditions other than acute coronary syndrome and heart failure. Clin Chem 2009, 55: 2098-2112. 10.1373/clinchem.2009.130799PubMedCrossRef

Title: The diagnostic challenge of myocardial infarction in critically ill patients: do high-sensitivity troponin measurements add more clarity or more confusion?
Authors: Kada Klouche
Olivier Jonquet
Jean Paul Cristol
Publication date: 01-06-2014
Publisher: BioMed Central
Published in: Critical Care / Issue 3/2014
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc13909

ACC 2024 Congress

Springer Medicine

The diagnostic challenge of myocardial infarction in critically ill patients: do high-sensitivity troponin measurements add more clarity or more confusion?

Abstract

ACC 2024 Congress

Springer Medicine

Abstract

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