Evidence map›Paper›PMID 30374693›Full record

ArticleIntensive care medicine2018

Unrecognised myocardial infarction and its relationship to outcome in critically ill patients with cardiovascular disease.

Annemarie B Docherty, Shirjel Alam, Anoop S Shah, Alastair Moss, David E Newby, Nicholas L Mills, Simon J Stanworth, Nazir I Lone, Timothy S Walsh, TROPICCAL Investigators

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Intensive care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Transfusion thresholds for guiding red blood cell transfusion.The Cochrane database of systematic reviews · 2021
    Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Review
  7. Cardiovascular Risks Associated with Gender and Aging.Journal of cardiovascular development and disease · 2019
    Review
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Annemarie B DochertyDepartment of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, 2nd Floor Anaesthetics Corridor, Royal Infirmary Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SA, UK. Annemarie.docherty@ed.ac.uk.
Shirjel AlamCentre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK.
Anoop S ShahCentre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK.
Alastair MossCentre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK.
David E NewbyCentre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK.
Nicholas L MillsCentre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK.
Simon J StanworthRadcliffe Department of Medicine, University of Oxford, Oxford, UK.
Nazir I LoneDepartment of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, 2nd Floor Anaesthetics Corridor, Royal Infirmary Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
Timothy S WalshDepartment of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, 2nd Floor Anaesthetics Corridor, Royal Infirmary Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
TROPICCAL Investigators

Funding

British Heart Foundation FS/16/14/32023National Blood Service/Scottish National Blood Transfusion Service funded by the NBS/SNBTSNational Blood Service/Scottish National Blood Transfusion Service This study was undertaken as part of ABD's PhD
6 · The paper itself

Abstract

purposeTo establish the incidence of myocardial infarction (MI) in ICU patients with co-existing cardiovascular disease (CVD), and explore its association with long-term survival.

methodsIn a multi-centre prospective cohort study in 11 UK ICUs, we enrolled 273 critically ill patients with co-existing CVD. We measured troponin I (cTnI) with a high sensitivity assay for 10 days; ECGs were carried out daily for 5 days and analysed by blinded cardiologists for dynamic changes. Data were combined to diagnose myocardial 'infarction', 'injury' or 'no injury' according to the third universal definition of MI. Patients were followed-up for 6 months. Regression and mediation analyses were used to explore relationships between acute physiological derangements, MI, and mortality.

resultscTnI was detected in all patients, with a rise/fall pattern consistent with an acute hit. In 73% of patients, this peaked on days 1-3 [median 114 ng/l (first, third quartiles: 27, 393)]. Serial ECGs indicated 24.2% (n = 66) of patients experienced MI, but > 95% were unrecognized by clinical teams. Type 2 MI was the most likely aetiology in all cases. A further 46.1% (n = 126) experienced injury (no ECG changes). Injury and MI were both associated with 6-month mortality (reference: no injury): OR injury 2.28 (95% CI 1.06-4.92, p = 0.035), OR MI 2.70 (95% CI 1.11-6.55, p = 0.028). Mediation analysis suggested MI partially mediated the relationship between acute physiological derangement and 6-month mortality (p = 0.002), suggesting a possible causal association.

conclusionsUndiagnosed MI occurs in around a quarter of critically ill patients with co-existing CVD and is associated with lower long-term survival.

Indexed as

AgedCardiovascular DiseasesCohort StudiesCritical IllnessFemaleHumansIncidenceIntensive Care UnitsLength of StayMaleMiddle AgedMyocardial InfarctionSurvival RateTroponin CUnited KingdomTroponin CCardiovascular diseaseCohort studyCritical careMyocardial infarctionTroponin

Identifiers

PMID30374693

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.