Diagnosis performance of high sensitivity troponin assay in out-of-hospital cardiac arrest patients

Abstract

PurposeEarly identification of the cause of out-of-hospital cardiac arrest (OHCA) remains a challenge. Our aim was to determine whether high-sensitivity cardiac troponin T (HsTnT) was useful to diagnose a recent coronary artery occlusion as the cause of OHCA. MethodsRetrospective study including OHCA patients evaluated by systematic coronary angiogram at hospital admission. HsTnT was assessed at ICU admission. Predictive factors of a recent coronary occlusion were identified by logistic regression. Net reclassification improvement (NRI) was calculated to estimate the potential enhancement of prediction with HsTnT. ResultsDuring the 5year study period, 272 patients (median age 60y, 76.5% men) were included, and a culprit coronary occlusion was found in 133 (48.9%). The optimum HsTnT cut-off to predict a recent coronary occlusion was 575ng/l (sensitivity 65.4%, specificity 65.5%). In multivariate analysis, current smoking (OR 3.2 95%, 95%CI 1.62–6.33), time from collapse to BLS<3min (OR 2.11, 95%CI 1.10–4.05), initial shockable rhythm (OR 5.29, 95%CI 2.06–13.62), ST-segment elevation (OR 2.44, 95%CI 1.18–5.03), post-resuscitation shock onset (OR 2.03, 95%CI 1.01–4.07) and HsTnT≥575ng/l (OR 2.22, 95%CI 1.16–4.27) were associated with the presence of a recent coronary occlusion. Nevertheless, adding HsTnT to established risk factors of recent coronary occlusion identified above provided a non-significant NRI of −0.43%. ConclusionsAdmission HsTnT is increased after OHCA and is an independent factor of a recent coronary occlusion. However, HsTnT does not seem to be a strong enough diagnostic tool to select candidates for emergent coronary angiogram in OHCA survivors.