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Type 2 Myocardial Infarction (T2MI) is an increasingly recognized clinical entity due to the availability of highly sensitive troponin assays for patients admitted due to common medical diagnoses. However, there is little epidemiological data on the significance and long-term prognosis of T2MI, which occurs secondary to an increase in myocardial oxygen demand and/or a decrease in myocardial blood flow. Arrhythmia, hypoxia, and sepsis are the major etiologies for T2MI. Therefore, sepsis was the identified area of interest for the study giving how common it is in a community hospital. We studied the cardiac workup of patients with elevated troponin in the context of sepsis due to acute medical illness to find out the prevalence of obstructive coronary artery disease (CAD) in this population. In this two-year retrospective, descriptive study, electronic medical records (EMR) were reviewed for all patients aged 18 years and older admitted to a single community teaching hospital with a diagnosis of sepsis and elevated troponin I (> 0.07 ug/L). The primary outcome was the presence of obstructive CAD. The secondary outcome was time to peak serum troponin. Of 222 patients, 40 patients underwent invasive or/and noninvasive cardiac testing for CAD. The study revealed 30% of patients admitted with T2MI due to sepsis have underlying obstructive coronary artery lesions. Troponin rose slower in patients with T2MI with underlying obstructive CAD. Pneumonia was the most common underlying cause of sepsis in both groups. Given the considerable prevalence of underlying flow-limiting coronary artery lesions, it may be advisable to evaluate for obstructive CAD sooner than later, during the index hospitalization, when patients developed elevated troponin secondary to sepsis.
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Salama A, Mehta N, Abdullah A, Kouides R, Depta J, Hoefen R, Alweis R. The Role of Coronary Artery Disease in Demand Mediated Myocardial Infarction: A Retrospective Study from a Community Hospital. Advances in Clinical Medical Research and Healthcare Delivery. 2021; 1(3). doi: 10.53785/2769-2779.1039.