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Systematic review of β blocker, aspirin, and statin in critically ill patients: importance of severity of illness and cardiac troponin
  1. Florence G Rothenberg1,2,
  2. Michael B Clay2,
  3. Hina Jamali1,
  4. Robin H Vandivier-Pletsch1,2
  1. 1University of Cincinnati, Cincinnati, Ohio, USA
  2. 2Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio, USA
  1. Correspondence to Florence G Rothenberg, University of Cincinnati, 231 Albert Sabin Way, ML 0542, Cincinnati, OH 45267, USA; florence.rothenberg{at}uc.edu

Abstract

Non-cardiac critically ill patients with type II myocardial infarction (MI) have a high risk of mortality. There are no evidence-based interventions to mitigate this risk. We systematically reviewed the literature regarding the use of medications known to reduce mortality in patients with cardiac troponin (cTn) elevation due to type I MI (β blockers, statin, and aspirin) in studies of critically ill patients without Type I MI. All PubMed publications between 1976–2/19/16 were reviewed. Search terms included: β blocker or aspirin or statin and intensive care unit (ICU) or critically ill or sepsis; 497 primary references were obtained. Inclusion criteria were as follows: (1) study population consisted of critically ill patients in the ICU with non-cardiovascular illnesses, (2) mortality end point, (3) severity of illness (or injury) was measured, and (4) the antiplatelet agent was primarily aspirin. Retrospective investigations, prospective observational studies, meta-analysis, systematic review, and randomized controlled trials were included; case reports were excluded. 25 primary references were obtained. The data were extracted and tabulated using data collection headings as follows: article title, first author/year/reference number, study type/design, population studied, outcome and intervention, and study question addressed. Evidence was not graded as the majority of studies were non-randomized (low-to-moderate quality). 11 studies were found through bibliography reviews for a total of 36 references. In conclusion, β blockers, statins, and aspirin may play a role in reducing mortality in non-cardiac critically ill patients. Benefit appears to be related to severity of illness, for which cTn may be a marker.

  • Myocardial Infarction
  • Troponin
  • Aspirin

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Footnotes

  • Contributors FGR, MBC, HJ and RHV-P have all contributed to the conception or design of the work, in revising this work critically for important intellectual content, have all contributed to the final version and have all agreed to be accountable for all aspects of the work.

  • Disclaimer This material is the result of work supported with resources and the use of facilities at the Cincinnati VAMC.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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