title: Systematic review of β blocker, aspirin, and statin in critically ill patients: importance of severity of illness and cardiac troponin.
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.
authors.affiliation: University of Cincinnati, Cincinnati, Ohio, USA.|Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio, USA.
authors.forename: Florence G
authors.initials: FG
authors.lastname: Rothenberg
authors.affiliation: Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Clay
authors.affiliation: University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Hina
authors.initials: H
authors.lastname: Jamali
authors.affiliation: University of Cincinnati, Cincinnati, Ohio, USA.|Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio, USA.
authors.forename: Robin H
authors.initials: RH
authors.lastname: Vandivier-Pletsch
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D016638:Critical Illness; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D009206:Myocardium / Q000378:metabolism*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D014336:Troponin / Q000378:metabolism*
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D014336:Troponin; D001241:Aspirin
keywords: Aspirin; Myocardial Infarction; Troponin