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


METHODS
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.


METHODS
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).


CONCLUSIONS
Myocardial injury occurs frequently in patients hospitalized for moderate to severe CO poisoning and is a significant predictor of mortality.
Henry
Christopher R
CR
Minneapolis Heart Institute Foundation, Minneapolis, Minn 55407, USA.
Satran
Daniel
D
Lindgren
Bruce
B
Adkinson
Cheryl
C
Nicholson
Caren I
CI
Henry
Timothy D
TD
D000328:Adult; D002249:Carbon Monoxide Poisoning / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D002423:Cause of Death; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006931:Hyperbaric Oxygenation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017741:Survivors; D019210:Troponin I / Q000097:blood
D019210:Troponin I; D052279:Creatine Kinase, MB Form