Can early cardiac troponin I measurement help to predict recent coronary occlusion in out-of-hospital cardiac arrest survivors
Critical Care Medicine, 05/24/2012
Dumas F et al. – 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.Methods
- 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.
- 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.
- 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 4.66ng.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.