Myocardial Injury Is Associated with the Incidence of Major Adverse Cardiac Events in Patients with Severe Trauma

Alexandra Stroda; Carina Jaekel; René M'Pembele; Alexander Guenther; Theresa Tenge; Carl Maximilian Thielmann; Simon Thelen; Erik Schiffner; Dan Bieler; Michael Bernhard; Ragnar Huhn; Giovanna Lurati Buse; Sebastian Roth

doi:10.3390/jcm11247432

Myocardial Injury Is Associated with the Incidence of Major Adverse Cardiac Events in Patients with Severe Trauma

J Clin Med. 2022 Dec 15;11(24):7432. doi: 10.3390/jcm11247432.

Authors

Affiliations

¹ Department of Anesthesiology, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Dusseldorf, Germany.
² Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Dusseldorf, Germany.
³ Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.
⁴ German Cancer Consortium (DKTK), 69120 Heidelberg, Germany.
⁵ Emergency Department, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Dusseldorf, Germany.
⁶ Department of Anesthesiology, Kerckhoff Heart and Lung Center, 61231 Bad Nauheim, Germany.

Abstract

Background: Severe trauma potentially results in end-organ damage such as myocardial injury. Data suggest that myocardial injury is associated with increased mortality in this cohort, but the association with the incidence of in-hospital major adverse cardiac events (MACE) remains undetermined.

Methods: Retrospective cohort study including adult patients with severe trauma treated at the University Hospital Duesseldorf between January 2016 and December 2019. The main exposure was myocardial injury at presentation. Endpoints were in-hospital incidence of MACE and incidence of acute kidney injury (AKI) within 72 h. Discrimination of hsTnT for MACE and AKI was examined by the receiver operating characteristic curve (ROC) and the area under the curve (AUC). We conducted multivariate logistic regression analysis.

Results: We included 353 patients in our final analysis (72.5% male (256/353), age: 55 ± 21 years). The AUC for hsTnT and MACE was 0.68 [95% confidence interval (CI): 0.59-0.78]. The AUC for hsTnT and AKI was 0.64 [95% (CI): 0.55-0.72]. The adjusted odds ratio (OR) for myocardial injury and MACE was 2.97 [95% (CI): 1.31-6.72], and it was 2.14 [95% (CI): 1.03-4.46] for myocardial injury and AKI.

Conclusion: Myocardial injury at presentation in patients with severe trauma is independently associated with the incidence of in-hospital MACE and AKI.

Keywords: cardiovascular complications; hemodynamics; multiple trauma; myocardial ischemia; prognosis.

Grants and funding

This research received no external funding.