In-hospital outcomes after acute myocardial infarction with obstructive coronary artery disease in critically ill patients hospitalized for non-cardiac disease

Annals of Intensive Care

Research

Stéphane Ederhy¹  Ariel Cohen²  Cyrielle Desnos³  Morgan Roué³  Muriel Fartoukh⁴  Vincent Labbé⁵  Elise Morawiec⁶  Geoffroy Hariri⁷  Keyvan Razazi⁸  Armand Mekontso Dessap⁸  Nathanaël Lapidus⁹  Alexis F. Guédon⁹ 

[1] Department of Cardiology, UNICO Cardio-Oncology Program, Hôpital Saint-Antoine, AP-HP, Paris, France;INSERM U 856, Paris, France;Department of Cardiology, UNICO Cardio-Oncology Program, Hôpital Saint-Antoine, AP-HP, Paris, France;INSERM U 856, Paris, France;Sorbonne Université, UMR-S ICAN 1166, Paris, France;Service de Médecine Intensive Réanimation, Département Médico-Universitaire APPROCHES, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France;Service de Médecine Intensive Réanimation, Département Médico-Universitaire APPROCHES, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France;Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de Recherche Biomédicale, INSERM, Créteil, France;Service de Médecine Intensive Réanimation, Département Médico-Universitaire APPROCHES, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France;Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de Recherche Biomédicale, INSERM, Créteil, France;Service des Soins Intensifs, Hôpital Universitaire Bruxelles, Université Libre de Bruxelles, Brussels, Belgium;Service de Médecine Intensive Réanimation, Hôpital La Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France;Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France;Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Département Médico-Universitaire Médecine, AP-HP, Créteil, France;Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de Recherche Biomédicale, INSERM, Créteil, France;Sorbonne Université, Public Health Department, Saint Antoine Hospital, AP-HP, Paris, France;Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Paris, France;

关键词: Acute myocardial infarction;    Intensive care unit;    Ischemic risk;    Bleeding risk;    Outcomes;    Coronary artery disease;   

DOI  :  10.1186/s13613-023-01188-9

 received in 2023-05-22, accepted in 2023-09-07,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAcute myocardial infarction (AMI) is one of the major cardiac complications in patients hospitalized in the intensive care unit (ICU) for non-cardiac disease. A better knowledge of ischemic and bleeding risks in these patients is needed to identify those most likely to benefit from specific cardiac management. We therefore assessed the incidence and predictors of a composite outcome of severe ischemic event (AMI recurrence, ischemic stroke), major bleeding, or all-cause death in this setting.MethodsIn this multicenter retrospective study, all consecutive adult patients admitted for non-cardiac disease to four French university hospital ICUs between January 2012 and December 2018 who had an AMI with obstructive coronary artery disease (OCAD) during the ICU stay were considered for inclusion. AMI with OCAD was defined as an elevated cardiac troponin value associated with at least one sign (clinical, electrocardiographic, or echocardiographic) suggestive of myocardial ischemia and presence of OCAD on coronary angiography. The primary endpoint was in-hospital occurrence of the composite outcome.ResultsNinety-six patients [median age 69 years, 22 women (23%), 59 with sepsis (61%), 35 with ST elevation (37%), median sequential organ failure assessment (SOFA) of 8 on the day of AMI] were included. The median peak cardiac troponin value was 131 (IQR 44–303) times the upper reference limit. Dual antiplatelet, therapeutic anticoagulation, and early mechanical reperfusion therapies were administered in 61 (64%), 68 (71%), and 47 (49%) patients, respectively. The composite outcome occurred in 48 (50%) patients. Severe ischemic events occurred in 17 (18%) patients and major bleeding in 26 (27%) patients; 26 patients (27%) died in the hospital. AMI management was not significantly different in patients with and without the composite outcome. A history of arterial hypertension (HR 2.05, 95% CI 1.01–4.16) and high SOFA score at the time of AMI (HR 1.07, 95% CI 1.00–1.15) were independent risk factors for the composite outcome.ConclusionsPatients who have an AMI with OCAD during an ICU stay for non-cardiac disease are at risk of a composite outcome of severe ischemia, major bleeding, and death. A history of arterial hypertension and high SOFA scores were independent hazards for poor prognosis.Graphical Abstract

【 授权许可】

CC BY   
© La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF) 2023

【 图 表 】

13690_2023_1170_Article_IEq173.gif

Fig. 1