Mustafa Özkoç1, Emrah Aksakal1, Ömer Faruk Derman2, Ibrahim Saraç1, Yavuzer Koza3

1Department of Cardiology, Rize State Hospital, Rize, Turkey
2Department of Cardiology, Erzurum City Hospital, Erzurum, Turkey
3Department of Cardiology, Recep Tayyip Erdoğan University Research and Education Hospital, Rize, Turkey
4Department of Cardiology, Atatürk University Research Hospital, Erzurum, Turkey

Keywords: Carbon monoxide poisoning, cardiotoxicity, cardiovascular risk, myocardial injury


OBJECTIVES: This single center, retrospective study investigates the predictive value of cardiovascular (CV) risk-calculation systems in patients admitted to the emergency department with carbon monoxide (CO) intoxication for the identification of potential myocardial injury.

METHODS: The total CV risk of 558 patients presenting to the emergency department with CO intoxication were calculated on admission using different CV risk scoring systems, including SCORE Turkey, European Heart SCORE, and FRAMINGHAM to predict potential myocardial injury secondary to poisoning, and the risk levels were categorized based on the calculated scores. The presence of myocardial injury was identified based on the level of elevation of a cardiac biomarker (Serum cardiac troponin-I >99th percentile upper reference limit).

RESULTS: Myocardial injury due to CO intoxication was detected in 132 (23.7%) of the patients. A comparison of the risk scoring systems’ ability to detect the presence of myocardial injury revealed that all had significant, similar, but low predictive values (the “area under the curve” values of SCORE Turkey, European Heart SCORE and FRAMINGHAM were 0.653, 0.632, and 0.629, respectively; P < 0.001). Among the three risk scoring systems, SCORE Turkey was the most successful test in diagnosing myocardial injury with 87% specificity, while FRAMINGHAM scoring was the most successful test in excluding the presence of myocardial injury with 72.1% sensitivity.

CONCLUSION: Among the tested CV risk calculation systems SCORE Turkey, was found to be the most effective in the prediction of myocardial injury secondary to CO poisoning, but all produced similar and significant results.

How to cite this article: Özkoç M, Aksakal E, Derman ÖF, Saraç I, Koza Y. Predictive value of cardiovascular risk scoring systems for the detection of myocardial injury following carbon monoxide intoxication. Turk J Emerg Med 2023;23:30-7.

Ethics Committee Approval

Institutional Review Board approval was obtained from the Atatürk University Board of Ethics on Clinical Studies Ethics Committee (Date: June 27, 2019, Number: B.30.2.ATA.0.01.00/363).

Author Contributions

Mustafa ÖZKOÇ:Review and editing (equal); conceptualization (lead); writing – original draft (lead).
Emrah AKSAKAL: Formal analysis (lead); writing – review and editing (equal).
Ömer Faruk DERMAN: Software (lead); writing – review and editing (equal).
İbrahim SARAÇ: Methodology (lead); writing – review and editing (equal).
Yavuzer KOZA: Conceptualization (supporting); Writing – original draft (supporting); Writing – review and editing (equal).

Conflict of Interest

None Declared.

Financial Disclosure