Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine.

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Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine.

Crit Care. 2013 Jun 20;17(3):R117

Authors: Mehta S, Granton J, Gordon AC, Cook DJ, Lapinsky S, Newton G, Bandayrel K, Little A, Siau C, Ayers D, Singer J, Lee TC, Walley KR, Storms M, Cooper JD, Holmes CL, Hebert P, Presneill J, Russell JA

INTRODUCTION: Cardiac troponins are sensitive and specific biomarkers of myocardial necrosis. We evaluated troponin, creatine kinase (CK), and electrocardiogram (ECG) abnormalities in patients with septic shock; and compared the effect of vasopressin (VP) vs norepinephrine (NE) on troponin, CK, and ECGs.
METHODS: This was a prospective substudy of a randomized trial. Adults with septic shock randomly received a blinded infusion of low-dose VP (0.01-0.03 U/min) or NE (5-15 mug/min) in addition to open-label vasopressors, titrated to maintain a mean blood pressure of 65-75 mmHg. Troponin I/T, CK, and CKMB were measured and 12-lead ECGs were recorded prior to study drug, and 6 hours, 2 days and 4 days after study drug initiation. Two physician readers, blinded to patient data and drug, independently interpreted ECGs.
RESULTS: We enrolled 121 patients [median age 63.9 years (IQR 51.1,75.3), mean Acute Physiology and Chronic Health Evaluation II (APACHE II) 28.6 (SD 7.7)]: 65 in VP group and 56 in NE group. At the 4 timepoints, 26%, 36%, 32% and 21% of patients had troponin elevations, respectively. Baseline characteristics and outcomes were similar between patients with positive versus negative troponin levels. Troponin and CK levels, and rates of ischemic ECG changes were similar in the VP and NE groups. In multivariable analysis only APACHE II was associated with 28-day mortality (OR 1.07, 95% CI 1.01-1.14, p=0.033).
CONCLUSIONS: Troponin elevation is common in adults with septic shock. We observed no significant differences in troponin, CK, and ECGs in patients treated with vasopressin and norepinephrine. Troponin elevation was not an independent predictor of mortality.

PMID: 23786655 [PubMed - as supplied by publisher]

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