Diagnostic and prognostic utility of cardiac troponin in post-cardiac arrest care

Agusala, Vijay; Khera, Rohan; Cheeran, Daniel; Mody, Purav; Reddy, Pranitha P; Link, Mark S.

doi:10.1016/j.resuscitation.2019.06.004

Cited by 7 publications

(4 citation statements)

References 19 publications

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Section: Introductionmentioning

confidence: 99%

“…Troponin testing has high sensitivity and specificity for myocardial injury, while elevated troponin levels are common after OHCA since myocardial injury occurs [ 4 , 5 ]. However, in several studies, the initial troponin level did not reflect the prognosis of OHCA patients [ 5 , 6 , 7 ]. Conversely, lactate may also be related to myocardial ischemia, while lactate clearance was related to OHCA prognosis in previous studies [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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The Association between Troponin-I Clearance after the Return of Spontaneous Circulation and Outcomes in Out-of-Hospital Cardiac Arrest Patients

Lee,

Ryu

2024

Rev. Cardiovasc. Med.

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Background: Elevated levels of troponin-I (TnI) are common in out-of-hospital cardiac arrest (OHCA) patients. However, studies evaluating the prognostic value of TnI clearance in OHCA patients are lacking. We aimed to examine how TnI clearance (TnI-C) differed according to the neurological outcome group and mortality group at 6 months. Methods: This retrospective observational study involved adults ( 18 years) who were treated for an OHCA between January 2019 and December 2022. The TnI-Cs were calculated for days 1 to 2 (TnI-C1st) and 2 to 3 (TnI-C2nd) after the return of spontaneous circulation (ROSC). The primary outcome was a poor neurological outcome at 6 months, defined by cerebral performance categories 3, 4, and 5. The secondary outcome was 6-month mortality. Results: A total of 227 patients were included. A poor neurological outcome and mortality at 6-months were reported in 150 (66.1%) and 118 (52.0%) patients, respectively. The TnI-C1st was significantly lower in patients with a poor outcome compared with good outcome patients (neurological outcome at 6 months, 54.4% vs. 42.3%; 6-month mortality, 52.1% vs. 42.7%, respectively). In the multivariable analyses, a TnI-C1st 50% was associated with a poor neurological outcome (odds ratio [OR] 2.078, 95% confidence interval [CI] 1.080–3.995, p = 0.028) and mortality (OR 2.131, 95% CI 1.114–4.078, p = 0.022) at 6 months. Conclusions: After ROSC, TnI-C1st 50% was associated with a poor neurological outcome and mortality at 6 months in OHCA patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association between Troponin-I Clearance after the Return of Spontaneous Circulation and Outcomes in Out-of-Hospital Cardiac Arrest Patients

Lee,

Ryu

2024

Rev. Cardiovasc. Med.

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“…Laboratory studies during advanced cardiovascular life support (ACLS) are conducted to determine the reversible cause of cardiac arrest in patients, and a serial follow-up of biomarkers performed at this time is used for prognosis, such as survival to discharge and neurologic outcome [8,9]. Serum biomarkers such as troponin and B-type natriuretic peptide have been studied as potential early predictors of OHCA [10,11], although these biomarkers have low accuracy when used alone and have been recommended to be used in combination [12,13]. OHCA is complex, and risk stratification tools have the potential to include components other than clinical risk indicators, which requires extensive studies [14].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Serum Lactate Dehydrogenase Level Measured in the Emergency Department in Predicting Clinical Outcome in Out-of-Hospital Cardiac Arrest: A Multicenter, Observational Study

Kim

2023

JCM

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Introduction: Out-of-hospital cardiac arrest (OHCA) is complex, and risk stratification tools have the potential to include components other than clinical risk indicators, thus requiring extensive studies. Simple and accurate biomarkers for OHCA patients with poor prognoses are still needed. Serum lactate dehydrogenase (LDH) has been identified as a risk factor in patients with various diseases, such as cancer, liver disease, severe infections, and sepsis. The primary aim of this study was to assess the accuracy of LDH values at initial presentation in the emergency department (ED) in predicting the clinical outcome in OHCA. Methods: This retrospective multicenter observational study was performed in the ED of two tertiary university hospitals and one general hospital between January 2015 and December 2021. All patients with OHCA who visited the ED were included. The primary outcome was the sustained return of spontaneous circulation (ROSC; >20 min) after advanced cardiac life support (ACLS). The secondary outcome was survival to discharge (including home care and nursing care discharge) among patients with ROSC. The neurological prognosis was considered a tertiary outcome in patients who survived to discharge. Results: In total, 759 patients were enrolled in the final analysis. The median LDH level in the ROSC group was 448 U/L (range: 112–4500), which was significantly lower than that in the no-ROSC group (p < 0.001). The median LDH level in the survival-to-discharge group was 376 U/L (range: 171–1620), which was significantly lower than that in the death group (p < 0.001). Using the adjusted model, the odds ratio of the LDH value (≤634 U/L) for primary outcomes was 2.418 (1.665–3.513) and the odds ratio of LDH value (≤553 U/L) for secondary outcomes was 4.961 (2.184–11.269). Conclusions: In conclusion, the serum LDH levels of patients with OHCA measured in the ED can potentially serve as a predictive marker for clinical outcomes such as ROSC and survival to discharge, although it may be difficult to predict neurological outcomes.

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“…The safety analysis in clinical CVS trials analyzes the harmful effects of electric shocks by assessment for pain and erythema, measurement of high-sensitivity troponin I (hsTnI), creatine phosphokinase (CPK), creatine kinase isoenzyme MB (CK-MB), monitoring for post-shock arrhythmias (tachyarrhythmia and bradyarrhythmia), and early and late ST-segment deviation [ 6 , 27 , 28 , 29 ]. The safety profile of electric shocks can be better assessed in CVS for atrial fibrillation (AF) than in cardiac arrest because the myocardium is perfused [ 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

A Randomized Comparison of Delivered Energy in Cardioversion of Atrial Fibrillation: Biphasic Truncated Exponential Versus Pulsed Biphasic Waveforms

et al. 2021

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A few randomized trials have compared impedance-compensated biphasic defibrillators in clinical use. We aim to compare pulsed biphasic (PB) and biphasic truncated exponential (BTE) waveforms in a non-inferiority cardioversion (CVS) study. This was a prospective monocentric randomized clinical trial. Eligible patients admitted for elective CVS of atrial fibrillation (AF) between February 2019 and March 2020 were alternately randomized to treatment with either a PB defibrillator (DEFIGARD TOUCH7, Schiller Médical, Wissembourg, France) or a BTE high-energy (BTE-HE) defibrillator (LIFEPAK15, Physio-Control Inc., Redmond, WA, USA). Fixed-energy protocol (200–200–200 J) was administered. CVS success was accepted if sinus rhythm was restored at 1 min post-shock. The study design considered non-inferiority testing of the primary outcome: cumulative delivered energy (CDE). Seventy-three out of 78 randomized patients received allocated intervention: 38 BTE-HE (52%), 35 PB (48%). Baseline characteristics were well-balanced between groups (p > 0.05). Both waveforms had similar CDE (mean ± standard deviation, 95% confidence interval): BTE-HE (253.9 ± 120.2 J, 214–293 J) vs. PB (226.0 ± 109.8 J, 188–264 J), p = 0.31. Indeed, effective PB shocks delivered significantly lower energies by mean of 25.6 J (95% CI 24–27.1 J, p < 0.001). Success rates were similar (BTE-HE vs. PB): 1 min first-shock (84.2% vs. 82.9%), 1 min CVS (97.4% vs. 94.3%), 2 h CVS (94.7% vs. 94.3%), 24 h CVS (92.1% vs. 94.3%), p > 0.05. Safety analysis did not find CVS hazards, reporting insignificant changes of myocardial-specific biomarkers, transient and rare ST-segment deviations, and no case of harmful tachyarrhythmias and apnea. Cardioversion of AF with fixed-energy protocol 200–200–200 J was highly efficient and safe for both PB and BTE-HE waveforms. These similar performances were achieved despite differences in the waveforms’ technical design, associated with significantly lower delivered energy for the effective PB shocks. Clinical Trial Registration: Registration number: NCT04032678, trial register: ClinicalTrials.gov.

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Diagnostic and prognostic utility of cardiac troponin in post-cardiac arrest care

Cited by 7 publications

References 19 publications

The Association between Troponin-I Clearance after the Return of Spontaneous Circulation and Outcomes in Out-of-Hospital Cardiac Arrest Patients

The Association between Troponin-I Clearance after the Return of Spontaneous Circulation and Outcomes in Out-of-Hospital Cardiac Arrest Patients

Diagnostic Value of Serum Lactate Dehydrogenase Level Measured in the Emergency Department in Predicting Clinical Outcome in Out-of-Hospital Cardiac Arrest: A Multicenter, Observational Study

A Randomized Comparison of Delivered Energy in Cardioversion of Atrial Fibrillation: Biphasic Truncated Exponential Versus Pulsed Biphasic Waveforms

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