title: Implication of cardiac marker elevation in patients who resuscitated from out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  It is often difficult to diagnose acute myocardial infarction (AMI) in patients who resuscitated after out-of-hospital cardiac arrest (OHCA) and had a delayed elevation in cardiac marker. This study explored whether elevations in cardiac marker were due to coronary artery occlusion or resulted from other causes.
  
  
  METHODS
  The study included 19 non-ST-segment elevation patients who resuscitated after OHCA and underwent delayed coronary angiography. We checked patients' serial creatine kinase-myocardial band (CK-MB) and troponin I (cTnI) levels on arrival and 6, 12, 24, 48, 72, and 96 hours postarrest. Based on the association of elevated cTnI and the results of their delayed angiographies, the patients were retrospectively divided into 2 groups: an AMI group (n=5) and a non-AMI group (n=14). We then analyzed the serial cardiac marker measurements in each group.
  
  
  RESULTS
  Peak marker levels were significantly higher in the AMI group than in the non-AMI group (CK-MB, 177.0±112.7 vs 66.4±85.2 ng/mL; P=.033 and cTnI, 40.4±14.5 vs 10.6±13.5 ng/mL; P=.005). After adjusting for covariates, the peak and 6-, 12-, and 24-hour cTnI and 6-hour CK-MB were significantly different between the 2 groups (P=.005, P=.004, P=.005, P=.020, and P=.007). In the non-AMI group, 3 patients had cTnI values that were within the reference range at all of the evaluated times. Most patients had only low cTnI elevations that rapidly fell back to normal.
  
  
  CONCLUSIONS
  The resuscitation of patients who experience sudden OHCA but do not have an AMI may lead to elevations of cardiac markers. However, these elevations are low and normalize early.
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Oh
authors.forename: Young Min
authors.initials: YM
authors.lastname: Kim
authors.forename: Han Joon
authors.initials: HJ
authors.lastname: Kim
authors.forename: Chun Song
authors.initials: CS
authors.lastname: Youn
authors.forename: Seung Pill
authors.initials: SP
authors.lastname: Choi
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Wee
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Won Jung
authors.initials: WJ
authors.lastname: Jeong
authors.forename: Kyu Nam
authors.initials: KN
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form