Elevated troponins in the ICU

Dr P.J. Devereaux is a professor in the Department of Health Research Methods, Evidence, and Impact and Department of Medicine and director of the Division of Cardiology at McMaster University.

Are elevated troponin levels a relevant finding in the intensive care unit (ICU)?

P.J. Devereaux, MD, PhD: Definitely, elevated troponin levels in the ICU are relevant.

There are some patients who are having type 2 myocardial infarctions (MIs) and a few will end up having type 1 MIs.

There is also myocardial injury, where you have troponin elevation but you do not have ischemic symptoms, ischemic electrocardiographic (ECG) changes, or echocardiographic findings of a new wall motion abnormality.

Many people also just have myocardial injury. All of them are prognostically relevant. A lot of the patients do have an underlying atherosclerotic disease, which likely can benefit from secondary prophylactic measures.

Ignoring troponin in the ICU is probably not in most patients’ best interest, but that does not mean that all these patients should be going to the cardiac catheterization laboratory. What definitely is in patients’ best interest is being evaluated for underlying coronary artery disease and getting on to good secondary prophylactic measures when they do have underlying coronary disease.