Purpose: The purpose of this study is to compare the clinical characteristics and outcomes of patients with and without coronary artery disease (CAD) confirmed by coronary angiography in critically ill patients clinically diagnosed with myocardial infarction.
Materials and methods: This retrospective observational study involved 56 patients who were clinically diagnosed with myocardial infarction and subsequently underwent coronary angiography during their intensive care unit stay.
Results: Only 18 patients (32%) were finally confirmed to have CAD by coronary angiography. There were no significant differences in laboratory findings and clinical outcomes between patients with and without CAD. However, patients who developed shock (P = .009) and needed vasopressor support (P = .021) were less likely to be diagnosed with CAD. In addition, regional wall motion abnormality on echocardiography was more frequently observed in patients with CAD (P = .072). In a multiple logistic regression analysis, male sex (adjusted odds ratio [OR], 5.093; 95% confidence interval [CI], 1.177-22.037) and focal hypokinesia on echocardiography (adjusted OR, 5.134; 95% CI, 1.071-24.614) were independently associated with CAD. However, development of shock was inversely associated with CAD (adjusted OR, 0.107; 95% CI, 0.019-0.606).
Conclusion: Coronary angiography in critically ill patients should only be performed in highly selected patients with predicting factors for CAD.
Keywords: Coronary angiography; Critical illness; Intensive care unit; Myocardial infarction.
Copyright © 2013 Elsevier Inc. All rights reserved.