Manini et al identified risk factors for in-hospital adverse cardiovascular events (ACVE) associated with an acute drug overdose. These can help to identify patients who may benefit from more aggressive management. The authors are from Mount Sinai Icahn School of Medicine, New York University, and University of California San Francisco.
Adverse cardiovascular events include:
(1) myocardial injury by serum biomarker or ECG
(2) shock
(3) ventricular tachycardia, ventricular fibrillation, torsades de points
(4) cardiac arrest
The most common drugs associated with ACVE include:
(1) digoxin
(2) ACE inhibitors
(3) beta blockers
(4) diuretics
(5) calcium channel blockers
Predictors for ACVE from multivariate analysis:
(1) QTc > 500 msec
(2) serum bicarbonate < 20 mEq/L (acidosis)
(3) history of cardiac disease (coronary artery disease or CHF)
|
Number of Predictors
|
ACVE Rate
|
|
0
|
2.9
|
|
1
|
27.2
|
|
2 or 3
|
90.2
|
Additional factors seen on univariate analysis:
(1) age > 60 years
(2) altered mental status
Performance:
• For >= 1 risk factors the sensitivity was 52% and specificity 94%.
• The presence of 2 or 3 risk factors had a positive predictive value of 91%.
