High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest - A targeted temperature management (TTM) trial substudy.
Predicting outcome of unconscious patients after successful resuscitation is challenging and better prognostic markers are highly needed. Ischemic heart disease is a common cause of out-of-hospital cardiac arrest (OHCA). Whether or not high-sensitivity troponin T (hs-TnT) is a prognostic marker among survivors of OHCA with both ischemic and non-ischemic aetiologies remains to be determined. We sought to evaluate the ability of hs-TnT to prognosticate all-cause mortality, death due to cardiovascular causes or multi-organ failure and death due to cerebral causes after OHCA. The influence of the level of target temperature management on hs-TnT as a marker of infarct size was also assessed.



A total of 699 patients from the targeted temperature management (TTM) trial were included and hs-TnT was analyzed in blood samples from 24, 48 and 72h after return of spontaneous circulation (ROSC). The endpoints were 180 day all-cause mortality, death due to cardiovascular causes or multi-organ failure and death due to cerebral causes. Subgroups based on the initial ECG after ROSC (STEMI vs all other ECG presentations) were analyzed.



Hs-TnT was independently associated with all-cause mortality which was driven by death due to cardiovascular causes or multi-organ failure and not cerebral causes (at 48h: OR 1.10, CI 1.01-1.20, p<0.05). Hs-TnT was also an independent predictor of death due to cardiovascular causes or multi-organ failure (at 48h: OR 1.13, CI 1.01-1.26, p<0.05). In patients with STEMI, hs-TnT was independently associated with death due to cardiovascular causes or multi-organ failure (at 48h: OR 1.47, CI 1.10-1.95, p<0.01). Targeted temperature management at 33°C was not associated with hs-TnT compared to 36°C.



After OHCA due to both ischemic and non-ischemic causes, hs-TnT is an independent marker of both all-cause mortality and death due to cardiovascular causes or multi-organ failure. Targeted temperature management at 33°C did not reduce hs-TnT compared to 36°C. Hs-TnT may be a marker of poor prognosis after OHCA and this should be taken into consideration in patients that present with high troponin levels.



The TTM-trial is registered and accessible at Clinicaltrials.gov (identifier: NCT01020916).
Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden. Electronic address: patrik.gilje@med.lu.se.
Patrik
P
Gilje
Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
Sasha
S
Koul
The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Jakob Hartvig
JH
Thomsen
Laboratory of Cardiovascular Research, Public Research Centre - Health (CRP Santé), Luxembourg.
Yvan
Y
Devaux
Department of Anesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.
Hans
H
Friberg
Department of Intensive Care, Leeuwarden Medical Centrum, Leeuwarden, The Netherlands.
Michael
M
Kuiper
Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.
Janneke
J
Horn
Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
Niklas
N
Nielsen
Intensive Care Unit, Santa Maria Degli Angeli, Pordenone, Italy.
Tomasso
T
Pellis
Department of Anesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg.
Pascal
P
Stammet
Department of Intensive Care, University Hospital of Wales, Cardiff, United Kingdom.
Matthew P
MP
Wise
The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Jesper
J
Kjaergaard
The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Christian
C
Hassager
Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
David
D
Erlinge
D000368:Aged; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D020107:Troponin T / Q000032:analysis / Q000097:blood
D015415:Biomarkers; D020107:Troponin T
High-sensitivity troponin T; Hypothermia; Out-of-hospital cardiac arrest; Prognosis; TTM-trial