The association of maximum Troponin values post out-of-hospital cardiac arrest with electrocardiographic findings, cardiac reperfusion procedures and survival to discharge: A sub-study of ROC PRIMED

Laurie J Morrison; Sean M Devlin; Michael C Kontos; Sheldon Cheskes; Tom P Aufderheide; Jim Christenson; Joseph P Ornato; Ian G Stiell; Valeria E Rac; Andrew J Thomas; Jane G Wigginton; Paul Dorian; Resuscitation Outcomes Consortium Investigators

doi:10.1016/j.resuscitation.2016.12.004

The association of maximum Troponin values post out-of-hospital cardiac arrest with electrocardiographic findings, cardiac reperfusion procedures and survival to discharge: A sub-study of ROC PRIMED

Resuscitation. 2017 Feb:111:82-89. doi: 10.1016/j.resuscitation.2016.12.004. Epub 2016 Dec 14.

Affiliations

¹ Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. Electronic address: morrisonl@smh.ca.
² Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, 3rd Floor, New York, NY, United States. Electronic address: sedevlin@gmail.com.
³ Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond, VA, United States. Electronic address: mkontos@mcvh-vcu.edu.
⁴ Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Sunnybrook Centre for Prehospital Medicine, Division of Emergency Medicine, Department of Family and Community Medicine University of Toronto, 77 Browns Line, Suite 100, Toronto, Ontario M8W 3S2, Canada. Electronic address: Sheldon.Cheskes@sunnybrook.ca.
⁵ Medical College of Wisconsin, Department of Emergency Medicine, 9200 W. Wisconsin Avenue, Pavilion 1P, Milwaukee, WI 53226, United States. Electronic address: TAufderh@mcw.edu.
⁶ University of British Columbia, Department of Emergency Medicine, Room 3300 3rd Floor, 910 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada. Electronic address: jim.christenson@ubc.ca.
⁷ Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, United States. Electronic address: ornato@aol.com.
⁸ Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Clinical Epidemiology Unit, F6 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. Electronic address: istiell@ohri.ca.
⁹ THETA (Toronto Health Economics and Technology Assessment) Collaborative, Toronto General Research Institute, University Health Network and Leslie Dan Pharmacy Building, 6th Floor, Room 651, 144 College Street, Toronto, Ontario M5S 3M2, Canada. Electronic address: valeria.rac@theta.utoronto.ca.
¹⁰ School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, United States. Electronic address: thomandr@ohsu.edu.
¹¹ University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States. Electronic address: jane.wigginton@utsw.edu.
¹² Division of Cardiology, Department of Medicine, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. Electronic address: DORIANP@smh.ca.

PMID: 27988273
DOI: 10.1016/j.resuscitation.2016.12.004

Abstract

Background: The role of Troponin (Tn) levels in the management of patients post out-of-hospital cardiac arrest (OHCA) is unclear.

Methods: All OHCA patients enrolled in the Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed analysis trial and admitted to hospital with a Tn level and a 12-lead electrocardiogram were stratified by ST elevation (STE) or no STE in a regression model for survival to discharge adjusted for Utstein predictors and site.

Results: Of the 15,617 enrolled OHCA patients, 4118 (26%) survived to admission to hospital; 17% (693) were STE and 77% (3188) were no STE with 6% unknown; 83% (3460) had at least one Tn level. Reperfusion rates were higher when Tn level >2ng/ml (p>0.1ng/ml) improved with a diagnostic cardiac catheterization (p<0.001).

Conclusions: Elevated Tn levels >2ng/ml were associated with improved survival to discharge in patients post OHCA with STE. Survival in patients with no STE and Tn values >0.1ng/ml was higher when associated with diagnostic cardiac catheterization or treated with reperfusion or revascularization.

Keywords: Angiography; Cardiopulmonary resuscitation; Fibrinolysis; Heart arrest; Thrombolysis.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cardiac Catheterization
Cardiopulmonary Resuscitation
Electrocardiography*
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / blood
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / physiopathology*
Out-of-Hospital Cardiac Arrest / therapy*
Reperfusion
Troponin / blood*

Substances

Troponin

Grants and funding

U01 HL077885/HL/NHLBI NIH HHS/United States