TABLE 3.
Variation in Cardiovascular Management Strategies Among Critically Ill Adults With Sepsis and Elevated Troponin I
| Cardiovascular Management Approach | |||||
|---|---|---|---|---|---|
| Primary Analysisa | Subgroup Analysesa,b | ||||
| Sepsis With Elevated Troponin I | Cardiovascular Disease | No Prior Cardiovascular Disease | Cardiovascular Disease or Cardiovascular Disease Equivalents | No Prior Cardiovascular Disease or Cardiovascular Disease Equivalents | |
| Median OR (95% CI) | Median OR (95% CI) | Median OR (95% CI) | Median OR (95% CI) | Median OR (95% CI) | |
| Total, n (%) | 27,665 (100) | 21,974 (79.4) | 5,691 (20.6) | 24,816 (89.7) | 2,849 (10.3) |
| Cardiovascular diagnostics | |||||
| Serial troponin I | 1.95 (1.84–2.06) | 1.95 (1.83–2.08) | 1.78 (1.65–1.90) | 1.92 (1.82–2.05) | 1.62 (1.52–1.72) |
| Trend troponin I to peak | 1.71 (1.63–1.80) | 1.84 (1.74–1.94) | 1.63 (1.54–1.73) | 1.81 (1.73–1.91) | 1.64 (1.54–1.76) |
| Echocardiography | 1.50 (1.45–1.55) | 1.56 (1.50–1.62) | 1.56 (1.48–1.65) | 1.55 (1.49–1.61) | 1.55 (1.46–1.65) |
| Cardiac stress test | 3.30 (2.94–3.66) | 3.63 (3.18–4.13) | 3.92 (3.31–4.67) | 3.41 (3.01–3.91) | 4.38 (3.64–5.30) |
| Cardiac catheterization | 2.16 (1.99–2.34) | 2.18 (2.02–2.37) | 2.50 (2.23–2.82) | 2.20 (2.02–2.41) | 1.90 (1.73–2.09) |
| Cardiovascular therapeutics | |||||
| Antiplatelet agents | 1.28 (1.24–1.31) | 1.28 (1.24–1.31) | 1.26 (1.22–1.30) | 1.27 (1.23–1.30) | 1.40 (1.34–1.46) |
| Therapeutic anticoagulation | 7.58 (6.43–8.77) | 8.98 (7.65–10.69) | 5.59 (4.61–6.70) | 9.02 (7.65–10.89) | 7.10 (5.67–8.87) |
| Beta-blockers | 1.28 (1.24–1.32) | 1.29 (1.25–1.33) | 1.19 (1.16–1.22) | 1.28 (1.25–1.32) | 1.19 (1.16–1.23) |
| Statins | 1.32 (1.28–1.36) | 1.35 (1.30–1.39) | 1.18 (1.15–1.20) | 1.34 (1.30–1.38) | 1.04 (1.03–1.05)c |
OR = odds ratio.
Covariates: Patient-level factors such as age, sex, race, ethnicity, history of myocardial infarction, congestive heart failure, cardiac arrhythmia, peripheral vascular disease, cerebrovascular disease, pulmonary circulation disease, diabetes mellitus, chronic kidney disease, hypertension, chronic pulmonary disease, liver disease, admission year, organ support therapies received, maximum admission Sequential Organ Failure Assessment score, and either first elevated troponin I level or maximum troponin I level. Facility-level factors such as hospital community type, hospital teaching status, hospital beds, and hospital geographic region.
Hospital geographic region excluded from all subgroup analyses to improve model fit.
Facility-level variables excluded from statin models of the no cardiovascular disease or cardiovascular disease equivalents cohort to avoid model singularity.