title: Can early cardiac troponin I measurement help to predict recent coronary occlusion in out-of-hospital cardiac arrest survivors?
abstract: 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.
  
  
  METHODS
  Retrospective analysis of a prospective electronic registry database.
  
  
  METHODS
  University cardiac arrest center.
  
  
  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.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Inserm UMR-S970, Paris Cardiovascular Research Centre, Paris Descartes University, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.forename: Stephane
authors.initials: S
authors.lastname: Manzo-Silberman
authors.forename: Jérôme
authors.initials: J
authors.lastname: Fichet
authors.forename: Zohair
authors.initials: Z
authors.lastname: Mami
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zuber
authors.forename: Benoît
authors.initials: B
authors.lastname: Vivien
authors.forename: Camille
authors.initials: C
authors.lastname: Chenevier-Gobeaux
authors.forename: Olivier
authors.initials: O
authors.lastname: Varenne
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Empana
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D054059:Coronary Occlusion / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D017741:Survivors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I