Coronary artery diseasePrognostic Implications of Normal (<0.10 ng/ml) and Borderline (0.10 to 1.49 ng/ml) Troponin Elevation Levels in Critically Ill Patients Without Acute Coronary Syndrome
Section snippets
Methods
The protocol was approved by the institutional review board at the Veterans Administration (VA) Medical Center, Bronx, New York. All patients with cTnI levels measured from June 1, 2005 to March 30, 2006 were identified retrospectively using the VA computerized medical records system. Serum cTnI values were sorted and identified as normal (<0.1 ng/ml), intermediate (0.1 to 1.49 ng/ml), or elevated (≥1.5 ng/ml). Occasionally multiple cTnI determinations for a given patient were available during
Results
Of the 266 patients in the ICU identified during the study period with normal or intermediate cTnI values, 26 were excluded because of ACS or chest pain presentations. The remaining 240 patients with normal (n = 150) or intermediate (n = 90) cTnI levels were included in the final analysis. Admitting diagnoses for these patients are presented in Table 1. There were significantly more perioperative patients with normal cTnI values, whereas more patients with a diagnosis of infection (sepsis or
Discussion
In patients presenting with ACS in the Thrombolysis In Myocardial Infarction 18 (TIMI-18) study,1 cTnI levels even in the intermediate range were associated with higher rates of cardiovascular events compared with normal cTnI values. Therefore, patients with ACS were specifically excluded from the present study, which was restricted to patients in the ICU without apparent clinically active cardiac issues. In these critically ill patients, our results show that even modest cTnI increases were
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