• Mikio Nakajima, Shotaro Aso, Hiroki Matsui, Richard H Kaszynski, Kiyohide Fushimi, Yoshihiro Yamaguchi, and Hideo Yasunaga.
• Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Shibuya-ku.
• Eur J Emerg Med. 2020 Jun 1; 27 (3): 213-216.

ObjectiveMore than one-third of patients with moderate to severe acute carbon monoxide (CO) poisoning had myocardial injury. However, the ratio of acute CO patients necessitating percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) remains unknown. This study aimed to examine the prevalence of myocardial injury requiring PCI or CABG in patients with CO poisoning.MethodsThis was a nationwide retrospective cohort study, using the Japanese Diagnosis Procedure Combination inpatient database focusing on the period between 2010 and 2017. We extracted data on patients diagnosed with CO poisoning and determined the prevalence of cases presenting with myocardial injury requiring PCI or CABG.ResultsWe identified 9091 eligible patients. Within this patient pool, eight patients underwent PCI within 2 days of admission. No patients required CABG. The prevalence of subsequent PCI was 0.09% (8/9091). The patients who required PCI had a significantly higher median age than those who did not (75 vs. 52 years of age, respectively). Patients requiring PCI were older and were more likely to have underlying comorbidities such as hypertension and diabetes mellitus.ConclusionThe present study reported a low prevalence of myocardial injury requiring PCI in acute CO poisoning patients. Although myocardial injury due to coronary artery occlusion would be a very rare presentation in the setting of acute CO poisoning, coronary occlusion should be taken into consideration for elderly patients and/or patients who have coronary risk factors.

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