Prevalence of Troponin Elevations in Patients With Cardiac Arrest and Implications for Assessing Quality of Care in Hypothermia Centers

Kontos, Michael C.; Ornato, Joseph P.; Kurz, Michael C.; Roberts, Charlotte; Gossip, Michelle; Dhindsa, Harinder; Reid, Renee; Peberdy, Mary Ann

doi:10.1016/j.amjcard.2013.05.024

Cited by 9 publications

(7 citation statements)

References 28 publications

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“…First, we were not able to study consecutive patients due to the requirement of written informed consent for blood sampling. Second, the majority of our patients were not examined by angiography, although the proportion in our study were comparable to the proportion examined by angiography in the main FINNRESUSCI Study [ 20 ] and in other studies [ 29 , 31 ]. Our study was not designed to assess the potential of hs-TnT to diagnose acute coronary occlusion and hs-TnT levels could still be of value for selecting patients who may benefit from coronary revascularization in OHCA-VF/VT.…”

Section: Discussionsupporting

confidence: 67%

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Prognostic value of high-sensitivity troponin T levels in patients with ventricular arrhythmias and out-of-hospital cardiac arrest: data from the prospective FINNRESUSCI study

et al. 2014

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IntroductionMyocardial dysfunction is common after out-of-hospital cardiac arrest (OHCA) and high-sensitivity troponin T (hs-TnT) levels may provide incremental prognostic information to established risk indices.MethodsA total of 155 patients with OHCA and a shockable rhythm (98% ventricular fibrillation; OHCA-VF/VT) had blood samples drawn within six hours of admission. Blood samples were also available after 24 hours, 48 hours, and 96 hours in subsets of patients. The endpoints of the study were hospital mortality and neurological status and mortality after one year.ResultsAdmission hs-TnT levels were higher than the 99-percentile of the general population (14 ng/L) in all patients (range 18 to 17837 ng/L). Admission hs-TnT levels were associated with acute coronary artery occlusion, time to return of spontaneous circulation, heart failure, and renal function. Admission hs-TnT levels were higher in one-year non-survivors compared to survivors (median 747 (quartile 1 to 3, 206 to 1061) ng/L versus 345 (184 to 740) ng/L, P =0.023) and in patients with a poor versus a favorable neurological outcome (739 (191 to 1061) ng/L versus 334 (195 to 716) ng/L, P =0.028). However, hs-TnT measurements did not add prognostic information to established risk variables in multivariate analyses. hs-TnT levels measured during the hospitalization for OHCA-VF/VT correlated closely with admission levels (r ≥0.63) and were inferior to Simplified Acute Physiology Score II (SAPS II) scores for the prediction of events during follow-up. hs-TnT dynamics did not discriminate between survivors and non-survivors or between a poor versus a favorable neurological outcome.Conclusionhs-TnT levels are elevated in critically ill patients with OHCA-VF/VT, but do not improve risk prediction.

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Section: Discussionsupporting

confidence: 67%

“…The very high hs-TnT levels observed in this study support this model. Previous studies using older troponin assays have also found troponin levels to exceed the upper reference limit in the majority of OHCA patients [ 29 - 31 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of high-sensitivity troponin T levels in patients with ventricular arrhythmias and out-of-hospital cardiac arrest: data from the prospective FINNRESUSCI study

et al. 2014

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“…After a period of VA, ST segments can be dynamic due to demand ischemia, which as well can cause elevated troponin levels in the absence of significant stenosis in any main coronary artery branch. Kontos et al 20 describe a troponin rise of at least 10 times the upper limit of normal in 85% of patients presenting with VA, even in most patients without significant coronary artery stenosis at coronary angiogram. In this study, most patients of the study group were diagnosed with ACS non‐ST‐elevation myocardial infarction (NSTEMI) due to ST‐segment depression on electrocardiography after resuscitation and/or elevated troponin levels, as these parameters are key in diagnozing NSTEMI 21 .…”

Section: Discussionmentioning

confidence: 99%

ICD implantation for secondary prevention in patients with ventricular arrhythmia in the setting of acute cardiac ischemia and a history of myocardial infarction

Dijk

Quast

Schaap

et al. 2020

Cardiovasc electrophysiol

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Introduction:In patients with a prior myocardial infarction (MI) but preserved left ventricular (LV) function, sustained ventricular arrhythmias (VAs) may arise in the setting of an acute coronary syndrome (ACS). It is unknown whether an implantable cardioverter-defibrillator (ICD) is mandatory in these patients as VA might be triggered by a reversible cause. The purpose of this study is to analyze the benefit of ICD therapy in this patient population. Methods:We conducted a retrospective observational study in ICD recipients implanted from 2008 to 2011. The study group consisted of patients with sustained VA in the setting of an ACS, with a history of MI, but with left ventricular ejection fraction (LVEF) greater than 35 (group A). The two control groups consisted of patients admitted with VA with a history of MI, but without ACS at presentation, either with LVEF greater than 35% (group B) or ≤35% (group C). The primary endpoint was the number of patients with appropriate ICD therapy (antitachycardia pacing or shock).Results: A total of 291 patients were included with a mean follow-up of 5.3 years.Appropriate ICD therapy occurred in 45.6% of the patients in group A vs 51.6% and 60.4% in groups B and C (P = .11). In group A, 31.1% received an appropriate ICD shock vs 34.7% and 44.3% in control groups B and C (P = .12).Conclusion: On the basis of these data, ICD implantation seems warranted in patients with history of MI presenting with VA in the setting of an ACS, despite preserved LV function and adequate revascularization. Further trials, preferably randomizes, should be performed to address these findings. K E Y W O R D Sacute coronary syndrome, ICD, secondary prevention, ventricular arrhythmia

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“…Another potential limitation is the relatively low rate of cardiac arrest patients who were diagnosed with NSTEMI, which can result from difficulties in diagnosis. Troponin elevations are seen in almost all patients who have cardiac arrest; whether this represents global myocardial damage or that related to MI can be difficult to determine in the absence of other confirmatory findings, such as angiography, or the ability to assess historical factors in patients who die before awakening. Finally, varying definitions of cardiac arrest can make it different to compare outcomes across studies.…”

Section: Limitationsmentioning

confidence: 99%

Association of acute myocardial infarction cardiac arrest patient volume and in‐hospital mortality in the United States: Insights from the National Cardiovascular Data Registry Acute Coronary Treatment And Intervention Outcomes Network Registry

Kontos

Fordyce

Chen

et al. 2019

Clinical Cardiology

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Background Little is known about how differences in out of hospital cardiac arrest patient volume affect in‐hospital myocardial infarction (MI) mortality. Hypothesis Hospitals accepting cardiac arrest transfers will have increased hospital MI mortality. Methods MI patients (ST elevation MI [STEMI] and non‐ST elevation MI [NSTEMI]) in the Acute Coronary Treatment Intervention Outcomes Network Registry were included. Hospital variation of cardiac arrest and temporal trend of the proportion of cardiac arrest MI patients were explored. Hospitals were divided into tertiles based on the proportion of cardiac arrest MI patients, and association between in‐hospital mortality and hospital tertiles of cardiac arrest was compared using logistic regression adjusting for case mix. Results A total of 252 882 patients from 224 hospitals were included, of whom 9682 (3.8%) had cardiac arrest (1.6% of NSTEMI and 7.5% of STEMI patients). The proportion of MI patients who had cardiac arrest admitted to each hospital was relatively low (median 3.7% [25th, 75th percentiles: 3.0%, 4.5%]).with a range of 4.2% to 12.4% in the high‐volume tertiles. Unadjusted in‐hospital mortality increased with tertile: low 3.8%, intermediate 4.6%, and high 4.7% ( P < 0.001); this was no longer significantly different after adjustment (intermediate vs high tertile odds ratio (OR) = 1.02; 95% confidence interval [0.90‐1.16], low vs high tertile OR = 0.93 [0.83, 1.05]). Conclusions The proportion of MI patients who have cardiac arrest is low. In‐hospital mortality among all MI patients did not differ significantly between hospitals that had increased proportions of cardiac arrest MI patients. For most hospitals, overall MI mortality is unlikely to be adversely affected by treating cardiac arrest patients with MI.

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Prevalence of Troponin Elevations in Patients With Cardiac Arrest and Implications for Assessing Quality of Care in Hypothermia Centers

Cited by 9 publications

References 28 publications

Prognostic value of high-sensitivity troponin T levels in patients with ventricular arrhythmias and out-of-hospital cardiac arrest: data from the prospective FINNRESUSCI study

Prognostic value of high-sensitivity troponin T levels in patients with ventricular arrhythmias and out-of-hospital cardiac arrest: data from the prospective FINNRESUSCI study

ICD implantation for secondary prevention in patients with ventricular arrhythmia in the setting of acute cardiac ischemia and a history of myocardial infarction

Association of acute myocardial infarction cardiac arrest patient volume and in‐hospital mortality in the United States: Insights from the National Cardiovascular Data Registry Acute Coronary Treatment And Intervention Outcomes Network Registry

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