title: Troponin Marker for Acute Coronary Occlusion and Patient Outcome Following Cardiac Arrest.
abstract: BACKGROUND
  The utility of troponin as a marker for acute coronary occlusion and patient outcome after out-of-hospital cardiac arrest (OHCA) is unclear. We sought to determine whether initial or peak troponin was associated with percutaneous coronary intervention (PCI), OHCA survival or neurological outcome.
  
  
  METHODS
  Single-center retrospective-cohort study of OHCA patients treated in a comprehensive clinical pathway from November 2007 to October 2012. Troponin I levels were acquired at presentation, four and eight hours after arrest, and then per physician discretion. Cardiac catheterization was at the cardiologist's discretion. Survival and outcome were determined at hospital discharge, with cerebral performance category score 1-2 defined as a good neurological outcome.
  
  
  RESULTS
  We enrolled 277 patients; 58% had a shockable rhythm, 44% survived, 41% good neurological outcome. Of the 107 (38%) patients who underwent cardiac catheterization, 30 (28%) had PCI. Initial ED troponin (median, ng/mL) was not different in patients requiring PCI vs no PCI (0.32 vs 0.09, p=0.06), although peak troponin was higher (4.19 versus 1.57, p=0.02). Of the 85 patients who underwent cardiac catheterization without STEMI (n=85), there was no difference in those who received PCI vs no PCI in initial troponin (0.22 vs 0.06, p=0.40) or peak troponin (2.58 vs 1.43, p=0.27). Regarding outcomes, there was no difference in initial troponin in survivors versus non-survivors (0.09 vs 0.22, p=0.11), or those with a good versus poor neurological outcome (0.09 vs 0.20, p=0.11). Likewise, there was no difference in peak troponin in survivors versus non-survivors (1.64 vs 1.23, p=0.07), or in those with a good versus poor neurological outcome (1.57 vs 1.26, p=0.14).
  
  
  CONCLUSIONS
  In our single-center patient cohort, peak troponin, but not initial troponin, was associated with higher likelihood of PCI, while neither initial nor peak troponin were associated with survival or neurological outcome in OHCA patients.
authors.affiliation: Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina.
authors.forename: David A
authors.initials: DA
authors.lastname: Pearson
authors.affiliation: Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Wares
authors.affiliation: Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Mayer
authors.affiliation: Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Runyon
authors.affiliation: Mecklenburg EMS Agency, Charlotte, North Carolina.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Studnek
authors.affiliation: Carolinas Health Care System, Dickson Advanced Analytics Group, Charlotte, North Carolina.
authors.forename: Shana L
authors.initials: SL
authors.lastname: Ward
authors.affiliation: Carolinas Health Care System, Dickson Advanced Analytics Group, Charlotte, North Carolina.
authors.forename: Kathi M
authors.initials: KM
authors.lastname: Kraft
authors.affiliation: Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina; Carolinas Medical Center, Department of Internal Medicine, Division of Critical Care Medicine, Charlotte, North Carolina.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Heffner
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D054059:Coronary Occlusion / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014336:Troponin / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D014336:Troponin