Electrocardiographic ST-segment elevation myocardial infarction in critically ill patients: An observational cohort analysis*

Continuing Medical Education Article Electrocardiographic ST-segment elevation myocardial infarction in critically ill patients: An observational coh...
Author: Aubrey Reynolds
2 downloads 0 Views 3MB Size
Continuing Medical Education Article

Electrocardiographic ST-segment elevation myocardial infarction in critically ill patients: An observational cohort analysis* Stephen L. Rennyson, MD; Jody Hunt, MD; Michael W. Haley, MD; H. James Norton, PhD; Laszlo Littmann, MD, PhD, FACP, FACC

LEARNING OBJECTIVES After participating in this educational activity, the participant should be better able to: 1. Assess the value of interpretation software diagnosis and troponin measurements for the diagnosis and further workup of ST-segment elevation myocardial infarction in intensive care unit patients. 2. Evaluate the concordance of the cardiologist interpretation of the EKG and the software interpretation of the electrocardiogram, as well as troponin levels in diagnosis and further workup in intensive care unit patients. Unless otherwise noted, the faculty’s, staff’s, and authors’ spouse(s)/life partner(s) (if any) have nothing to disclose. The authors have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. All faculty and staff in a position to control the content of this CME activity have disclosed that they have no financial relationship with, or financial interests in, any commercial companies pertaining to this educational activity. Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit.

Objective: To investigate the specificity of the electrocardiographic diagnosis of ST-segment elevation myocardial infarction in the critical care unit setting. Design: Retrospective observational cohort analysis. Setting: An 880-bed tertiary care teaching hospital with 120 intensive care unit beds. Patients: The population included medical, surgical, trauma, and neurosurgical intensive care unit patients. Interventions: Electrocardiograms were systematically collected to include all consecutive recordings over a 15-month period in which the interpretation software indicated ***ACUTE MI***. Patient demographics, markers of intensive care unit complexity, and hospital mortality were ascertained. The electrocardiograms were then further evaluated by a blinded, board-certified cardiologist for agreement or disagreement with the interpretation software. Serum troponin measurements obtained within 96 hrs of electrocardiogram acquisition were used to determine the likelihood of myocardial infarction. Measurements and Main Results: Over the 15-month study period, the interpretation software diagnosed ST-segment elevation myocardial infarction in 67 of 2243 intensive care unit patients (2.99%) who had an electrocardiogram performed. In the final study

*See also p. 2412. Cardiology Fellow (SLR), Medical College of Virginia, Richmond, VA; Fellow (JH), Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Birmingham-Alabama, Birmingham, AL; Associate Program Director (MWH), Department of Inter-

2304

population of 46 cases with electrocardiographic ST-segment elevation myocardial infarction, 85% had peak troponin elevation

Suggest Documents