Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning

Henry, Christopher R.; Satran, Daniel; Lindgren, Bjorn; Adkinson, C.; Nicholson, Caren I.; Henry, Timothy D.

doi:10.1001/jama.295.4.398

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Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning
Citation	Henry CR, Satran D, Lindgren B, Adkinson C, Nicholson CI, Henry TD. J. Am. Med. Assoc. JAMA 2006; 295(4): 398-402.
Affiliation	Minneapolis Heart Institute Foundation, Minneapolis, Minn 55407, USA.
Copyright	(Copyright © 2006, American Medical Association)
DOI	10.1001/jama.295.4.398
PMID	16434630
Abstract	CONTEXT: Carbon monoxide (CO) poisoning is a common cause of toxicological morbidity and mortality. Myocardial injury is a frequent consequence of moderate to severe CO poisoning. While the in-hospital mortality for these patients is low, the long-term outcome of myocardial injury in this setting is unknown. OBJECTIVE: To determine the association between myocardial injury and long-term mortality in patients following moderate to severe CO poisoning. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 230 consecutive adult patients treated for moderate to severe CO poisoning with hyperbaric oxygen and admitted to the Hennepin County Medical Center, a regional center for treatment of CO poisoning, between January 1, 1994, and January 1, 2002. Follow-up was through November 11, 2005. MAIN OUTCOME MEASURE: All-cause mortality. RESULTS: Myocardial injury (cardiac troponin I level > or =0.7 ng/mL or creatine kinase-MB level > or =5.0 ng/mL and/or diagnostic electrocardiogram changes) occurred in 85 (37%) of 230 patients. At a median follow-up of 7.6 years (range: in-hospital only to 11.8 years), there were 54 deaths (24%). Twelve of those deaths (5%) occurred in the hospital as a result of a combination of burn injury and anoxic brain injury (n = 8) or cardiac arrest and anoxic brain injury (n = 4). Among the 85 patients who sustained myocardial injury from CO poisoning, 32 (38%) eventually died compared with 22 (15%) of 145 patients who did not sustain myocardial injury (adjusted hazard ratio, 2.1; 95% confidence interval, 1.2-3.7; P = .009). CONCLUSION: Myocardial injury occurs frequently in patients hospitalized for moderate to severe CO poisoning and is a significant predictor of mortality.