0033 : Can cardiac troponin I measurement help to predict recent coronary occlusion in out-of-hospital cardiac arrest survivors?

Abstract

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 post resuscitation electrocardiogram pattern or clinical features are poorly sensitive in this setting. We searched to evaluate if a measurement of cardiac troponin I can help to detect a recent coronary lesion in out-of-hospital cardiac arrest. Between January 2012 and Juin 2013, 54 out-of-hospital cardiac arrest survivors have been consecutively studied. An immediate coronary angiography has been systematically performed. Blood cardiac troponin I levels at admission were analyzed to assess the optimum cutoff for identifying a recent coronary lesion, using ROC curves with the criterion of Youden. During coronary angiography, a coronary artery disease has been detected in 36 of 54 patients (66%). The optimum cardiac troponin I threshold was determined at 0,5μg/l Significant coronary artery disease was observed in 76% of patients with troponin I >0,5μg/l and in 12% of patients with troponin I < 0,5μg/l (p=0.001) (sensitivity 97%, specificity 41%). In this cohort of out-of-hospital cardiac arrest patients, isolated cardiac troponin I measurement is modestly predictive of a recent coronary lesion. 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 angiography.