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. 2023 Oct 14;3(2):101191.
doi: 10.1016/j.jscai.2023.101191. eCollection 2024 Feb.

The Prognostic Value of Troponin-T in Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: A COACT Substudy

Eva M Spoormans  1 , Jorrit S Lemkes  1 , Gladys N Janssens  1 , Nina W van der Hoeven  1 , Lucia S D Jewbali  2 , Eric A Dubois  2   3 , Martijn Meuwissen  4 , Tom A Rijpstra  5 , Hans A Bosker  6 , Michiel J Blans  7 , Gabe B Bleeker  8 , Remon Baak  9 , Georgios J Vlachojannis  10   11 , Bob J W Eikemans  12 , Pim van der Harst  11   13 , Iwan C C van der Horst  14   15 , Michiel Voskuil  11 , Joris J van der Heijden  16 , Albertus Beishuizen  17 , Martin Stoel  18 , Cyril Camaro  19 , Hans van der Hoeven  20 , José P Henriques  21 , Alexander P J Vlaar  22 , Maarten A Vink  23 , Bas van den Bogaard  24 , Ton A C M Heestermans  25 , Wouter de Ruijter  26 , Thijs S R Delnoij  15 , Harry J G M Crijns  27 , Pranobe V Oemrawsingh  28 , Marcel T M Gosselink  29 , Koos Plomp  30 , Michael Magro  31 , Paul W G Elbers  32 , Stéphanie van der Pas  33   34 , Niels van Royen  1   19
Affiliations

The Prognostic Value of Troponin-T in Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: A COACT Substudy

Eva M Spoormans et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: In out-of-hospital cardiac arrest (OHCA) without ST-elevation, predictive markers that can identify those with a high risk of acute coronary syndrome are lacking.

Methods: In this post hoc analysis of the Coronary Angiography after Cardiac Arrest (COACT) trial, the baseline, median, peak, and time-concentration curves of troponin-T (cTnT) (T-AUC) in OHCA patients without ST-elevation were studied. cTnT values were obtained at predefined time points at 0, 3, 6, 12, 24, 36, 28, and 72 hours after admission. All patients who died within the measurement period were not included. The primary outcome was the association between cTnT and 90-day survival. Secondary outcomes included the association of cTnT and acute thrombotic occlusions, acute unstable lesions, and left ventricular function.

Results: In total, 352 patients were included in the analysis. The mean age was 64 ± 13 years (80.4% men). All cTnT measures were independent prognostic factors for mortality after adjustment for potential confounders age, sex, history of coronary artery disease, witnessed arrest, time to BLS, and time to return of spontaneous circulation (eg, for T-AUC: hazard ratio, 1.44; 95% CI, 1.06-1.94; P = .02; P value for all variables ≤.02). Median cTnT (odds ratio [OR], 1.58; 95% CI, 1.18-2.12; P = .002) and T-AUC (OR, 2.03; 95% CI, 1.25-3.29; P = .004) were independent predictors for acute unstable lesions. Median cTnT (OR, 1.62; 95% CI, 1.17-2.23; P = .003) and T-AUC (OR, 2.16; 95% CI, 1.27-3.68; P = .004) were independent predictors for acute thrombotic occlusions. CTnT values were not associated with the left ventricular function (eg, for T-AUC: OR, 2.01; 95% CI, 0.65-6.19; P = .22; P value for all variables ≥.14).

Conclusion: In OHCA patients without ST-segment elevation, cTnT release during the first 72 hours after return of spontaneous circulation was associated with clinical outcomes.

Keywords: acute coronary syndrome; coronary angiography; out-of-hospital cardiac arrest.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Troponin T (cTnT) concentrations. (A) Median cTnT values in the first 72 hours of admission. (B) Median cTnT values in cardiac arrest survivors and nonsurvivors. (C) Median cTnT values in patients with nonsignificant coronary artery disease (CAD), significant CAD, and acute unstable lesions.
Central Illustration
Central Illustration
Troponin T (cTnT) concentrations and Area under the receiver operating characteristic (ROC) curve. Median cTnT values in cardiac arrest survivors and nonsurvivors. ROC for serial troponin T (cTnT) values and survival.
Figure 2
Figure 2
Area under the receiver operating characteristic (ROC) curve. (A) ROC for serial troponin T (cTnT) values and survival. (B) ROC for serial cTnT values and neurologic outcome. (C) ROC curve for serial cTnT values and acute unstable lesions. (D) ROC curve for serial cTnT values and acute thrombotic occlusions.
See this image and copyright information in PMC

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