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Can early cardiac troponin I measurement help to predict recent coronary occlusion in out-of-hospital cardiac arrest survivors?

Dumas, Florence MD, MPH; Manzo-Silberman, Stephane MD; Fichet, Jérôme MD; Mami, Zohair MD; Zuber, Benjamin MD; Vivien, Benoît MD, PhD; Chenevier-Gobeaux, Camille MD; Varenne, Olivier MD, PhD; Empana, Jean-Philippe MD, PhD; Pène, Frédéric MD, PhD; Spaulding, Christian MD, PhD; Cariou, Alain MD, PhD

doi: 10.1097/CCM.0b013e3182474d5e
Clinical Investigations

Objective: Recent guidelines recommend the immediate performance of a coronary angiography when an acute myocardial infarction is suspected as a cause of out-of-hospital cardiac arrest. However, prehospital factors such as postresuscitation electrocardiogram pattern or clinical features are poorly sensitive in this setting. We searched to evaluate if an early measurement of cardiac troponin I can help to detect a recent coronary occlusion in out-of-hospital cardiac arrest.

Design: Retrospective analysis of a prospective electronic registry database.

Setting: University cardiac arrest center.

Patients: Between January 2003 and December 2008, 422 out-of-hospital cardiac arrest survivors without obvious extra-cardiac cause have been consecutively studied. An immediate coronary angiography has been systematically performed. The primary outcome was the finding of a recent coronary occlusion.

Intervention: First, blood cardiac troponin I levels at admission were analyzed to assess the optimum cutoff for identifying a recent coronary occlusion. Second, a logistic regression was performed to determine early predictive factors of a recent coronary occlusion (including cardiac troponin I) and their respective contribution.

Measurements and Main Results: An ST-segment elevation was present in 127 of 422 patients (30%). During coronary angiography, a recent occlusion has been detected in 193 of 422 patients (46%). The optimum cardiac troponin I threshold was determined at 4.66 ng·mL−1 (sensitivity 66.7%, specificity 66.4%). In multivariate analyses, in addition of smoking and epinephrine initial dose, cardiac troponin I (odds ratio 3.58 [2.03–6.32], p < .001) and ST-segment elevation (odds ratio 10.19 [5.39–19.26], p < .001) were independent predictive factors of a recent coronary occlusion.

Conclusions: In this large cohort of out-of-hospital cardiac arrest patients, isolated early cardiac troponin I measurement is modestly predictive of a recent coronary occlusion. Furthermore, the contribution of this parameter even in association with other factors does not seem helpful to predict recent occlusion. As a result and given the high benefit of percutaneous coronary intervention for such patients, the dosage of cardiac troponin I at admission could not help in the decision of early coronary angiogram.

From the Inserm UMR-S970, Paris Cardiovascular Research Centre (FD, J-PE, CS, AC), Paris Descartes University, Paris, France; Medical Intensive Care Unit (JF, BZ, FP, AC), AP-HP, Broca-Cochin-Hôtel Dieu Hospital, Paris, France; Paris Descartes University & Paris Cité Sorbonne–Medical School (SM-S, BZ, BV, OV, FP, CS, AC), Paris, France; Departments of Emergency (FD), Cardiology (SM-S, ZM, OV, CS), and Clinical Chemistry (CC-G), Cochin-Hôtel Dieu Hospital, AP-HP, Paris, France; and SAMU 75 (BV), AP-HP, Necker Hospital, Paris, France.

This study was funded, in part, by a grant from the Agence Nationale pour la Recherche (Paris, France).

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: alain.cariou@cch.aphp.fr

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins