High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest – A targeted temperature management (TTM) trial substudy

Abstract

High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest -A targeted temperature management (TTM) trial substudyGilje, Patrik; Koul, Sasha; Thomsen, Jakob Hartvig; Devaux, Yvan; Friberg, Hans; Kuiper, Michael; Horn, Janneke; Nielsen, Niklas; Pellis, Tomasso; Stammet, Pascal; Wise, Matthew P.; Kjaergaard, Jesper; Hassager, Christian; Erlinge, David Link to publication Citation for published version (APA): Gilje, P., Koul, S., Thomsen, J. H., Devaux, Y., Friberg, H., Kuiper, M., ... Erlinge, D. (2016). High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest -A targeted temperature management (TTM) trial substudy. Resuscitation, 107, 156-161. DOI: 10.1016/j.resuscitation.2016 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal 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. Methods:A total of 699 patients from the Targeted Temperature Management (TTM) trial were included and hs-TnT was analysed in blood samples from 24, 48 and 72 h 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 analysed. Results: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 ...

N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Indicator for 30-Day Mortality Following Out-of-Hospital Cardiac Arrest: A prospective observational study

“…As previously demonstrated [9], we found that essentially all resuscitated OHCApatients had elevated levels of hs-cTnT. Gilje et al [20] found that hs-cTnT peaked 24 hours after admission following OHCA, but only hs-cTnT at 48 and 72 hours, respectively, was independently associated with all-cause mortality. In our study, we analysed only one blood sample very close to the cardiac arrest, which may not re ect the peak values of hs-cTnT, and the prognostic utility may have been missed.…”

“…Although cardiac biomarkers may be useful for prognostication in OHCA-patients, available data regarding the predictive value of high-sensitivity cardiac troponin-T (hs-cTnT) [9,[19][20][21], copeptin [21][22][23] and NT-proBNP [19,21,24,25] diverge. The inconsistency in previously reported results may be related to heterogeneity in the patient population with respect to cause of cardiac arrest and primary heart rhythm, timing of blood sampling and follow-up time.…”

Incremental Value of Circulating MiR-122-5p to Predict Outcome after Out of Hospital Cardiac Arrest

“…Serum blood samples obtained 48 hours after ROSC were used for miR-122-5p assessment. This time-point was chosen for consistency with past studies 11 , 15 , 23 , 30 and because the predictive value of NSE was highest 48 hours after cardiac arrest 9 . The miRNA cohort had comparable demographic and clinical characteristics to the entire TTM cohort, except that fewer patients from the miRNA cohort had a medical history of myocardial infarction (Table S1 in the Online supplement).…”

Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients

“…Elevated circulating troponin levels are specific for cardiomyocyte injury but not for myocardial infarction 100 . In resuscitated OHCA patients troponin levels are almost always elevated as a result of myocardial damage and the levels of troponins are related to the duration of resuscitation 101,102 , and to prognosis 103 . Geri et al 104 conducted a study with the aim of determining whether or not assay of high-sensitivity cardiac troponin T was useful in diagnosis of recent coronary-artery occlusion as the cause of OHCA.…”