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ST-segment elevation in ECG combined with elevated high sensitive troponin-I is associated with worse long-term prognosis in ICU patients
1Hospital Lariboisiere, Inserm UMR-S 942 and Anesthesia and Critical Care Department - Paris - France
In critically ill patients, ST-segment elevation (STE) in ECG has been poorly described and its association with long-term outcome is unknown.
The aim was to investigate the incidence of STE and its association with 1-year mortality in Intensive Care Unit (ICU) patients.
The FROG-ICU (NCT 01367093) is a prospective, observational study in 2087 patients, conducted in 21 ICUs in 14 European hospitals. In this sub-study, patients with at least one ECG available during the first 3 days after ICU admission were included. ECGs were analysed digitally and STE was defined according to the Third Universal Definition (1). High sensitive troponin-I (hs-TnI) was measured at inclusion. Three groups of patients were created: 1) No STE and normal hs-TnI. 2) Either STE or elevated hs-TnI. 3) Both STE and elevated hs-TnI.
Cox multivariate regression analysis for 1-year mortality was conducted and the final adjusted model included Simplified Acute Physiology Score II (SAPS II), Charlson Comorbidity Index, gender, hs-TnI at inclusion and cardiac arrest as cause for ICU admission.
In the 738 included patients, 93 (13%) displayed STE. Patients with STE were older (64 years (±18) vs. 59 years (±17), p=0.009), more often male (n=72 (77%) vs. n=425 (66%), p=0.036) and had more comorbidities. Cardiac arrest or cardiogenic shock as cause for ICU admission was more common in STE and hs-TnI was higher (64 ng/l (14-348) vs. 26 ng/l (8-177) p=0.023) (Table). One-year mortality was higher in patients with STE (n=45 (49%) vs. n=206 (32%), p<0.001, Figure A) and STE was associated with mortality in the adjusted cox model (HR 1.52-IC95% (1.09-2.11), p=0.013). Patients with both STE and elevated hs-TnI had two-fold mortality in comparison with no STE and normal hs-TnI (n=25 (49%) vs. n=98 (27%), p<0.001, Figure B).
STE is associated with increased long-term mortality in ICU patients. Combined STE and elevated hs-TnI define patients with the highest mortality risk.
1. Thygesen K et al Third Universal Definition of Myocardial Infarction. J Am Coll Cardiol. 2012 Oct 16;60(16):1581–98.
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