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Lundin A, Svensson CJ, Hansson VU, Thorsson M, Oras J. High-sensitivity troponin T for detection of culprit lesions in patients with out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2024. [PMID: 38819029 DOI: 10.1111/aas.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Patients with an out-of-hospital cardiac arrest (OHCA) often undergo coronary angiography, although a culprit lesion is found in only 30%-40% of patients. The aim of this study was to investigate high-sensitivity troponin T (hsTnT) levels in post cardiac arrest patients with and without coronary culprit lesions; factors affecting hsTnT levels after return of spontaneous circulation (ROSC); and the diagnostic ability of hsTnT in identifying patients with culprit lesions. We hypothesized that peak hsTnT levels were higher during the initial 48 h after cardiac arrest in patients with a coronary culprit lesion. METHODS This was a retrospective observational study, which included patients admitted to the Intensive Care Unit after an OHCA and who received a coronary angiography. Peak values and dynamic changes in hsTnT were analyzed in relation to the presence of a culprit lesion at coronary angiography. RESULTS A total of 238 patients were studied, of whom 140 had a culprit lesion. HsTnT levels during the initial 48 h were higher in patients with culprit lesions, longer time to ROSC and an unwitnessed cardiac arrest. At 6 to 12 h after ROSC, a hsTnT cut-off level of 1690 ng/L had a sensitivity of 64% and specificity of 84% to identify a culprit lesion. In patients without ST-elevations, hsTnT measured between 6 and 12 h after ROSC had a specificity above 90%, with a sensitivity of 46%. CONCLUSION HsTnT levels after cardiac arrest are higher in patients with coronary culprit lesions. Presence of a culprit lesion, witnessed status and the duration of CPR are important factors affecting hsTnT levels. Repeated measurement of hsTnT within the first 12 h after admission improved diagnostic accuracy but the value of hsTnT as a predictor of culprit lesions early after OHCA is limited.
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Affiliation(s)
- Andreas Lundin
- Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Johan Svensson
- Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Victor Utas Hansson
- Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Thorsson
- Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonatan Oras
- Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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2
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Elad B, Aronson D, Cohn-Schwartz D, Kapeliovich M. Diagnostic Value of High-Sensitivity Cardiac Troponin-I in Patients After Out-of-Hospital Cardiac Arrest. Am J Cardiol 2023; 207:253-256. [PMID: 37757522 DOI: 10.1016/j.amjcard.2023.08.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Knowing the etiology of cardiac arrest (CA) is important for treatment decisions. Results of previous studies on the diagnostic role of cardiac troponin in patients resuscitated from CA are controversial, few studies were done during the era of high-sensitivity cardiac troponin-I (hs-cTnI), and kinetics of hs-cTnI was not thoroughly investigated. We aimed to explore the diagnostic value of hs-cTnI in patients resuscitated from out-of-hospital CA (OHCA). This retrospective study included 201 consecutive patients after OHCA admitted to the intensive cardiac care unit at Rambam Health Care Campus from 2016 to 2021. Patients were divided into 2 groups according to etiology of CA: group 1-patients with definite acute myocardial infarction (AMI), group 2-patients in whom AMI was excluded. Values of hs-cTnI on admission, peak hs-cTnI, and hs-cTnI upslope were compared between patients with AMI and non-AMI. Peak hs-cTnI and hs-cTnI upslope differed significantly between patients with non-AMI versus AMI CA (median 1,424 vs 32,558 ng/L, p <0.0001 and median 109 vs 2,322 ng/L/h, p <0.0001, respectively). Moreover, peak hs-cTnI and hs-cTnI upslope were found to have good discrimination performance between patients with non-AMI and AMI, with area under the curve receiver operating characteristics (ROC) curves of 0.83 and 0.80, respectively. In conclusion, in patients resuscitated from OHCA values of peak hs-cTnI and hs-cTnI upslope could be helpful in the diagnosis of etiology of CA as adjunct to other diagnostic methods.
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Affiliation(s)
- Boaz Elad
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Doron Aronson
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Doron Cohn-Schwartz
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Michael Kapeliovich
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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3
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Brami P, Picard F, Seret G, Fischer Q, Pham V, Varenne O. Intracoronary imaging in addition to coronary angiography for patients with out-of-hospital cardiac arrest: More information for better care? Arch Cardiovasc Dis 2023; 116:272-281. [PMID: 37117094 DOI: 10.1016/j.acvd.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/30/2023]
Abstract
About 70% of out-of-hospital cardiac arrests are related to an ischaemic heart disease in Western countries. Percutaneous coronary intervention has been shown to improve the prognosis of survivors when an unstable coronary lesion is identified as the potential cause of the cardiac arrest. Acute complete coronary occlusion is often demonstrated among patients with ST-segment elevation on electrocardiogram after the return of spontaneous circulation. In patients without ST-segment elevation, routine coronary angiography has been shown to be not superior to conservative management. However, an electrocardiogram-based decision to perform immediate coronary angiography could be insufficient to identify unstable coronary lesions, which are frequently associated with intermediate coronary stenosis. Intracoronary imaging can be helpful to detect plaque rupture or erosion and intracoronary thrombus, but could also lead to better stent implantation, and help to reduce the risk of stent thrombosis. In patients with coronary lesions without the instability characteristic, conservative management should be the default strategy, and a search for another cause of the cardiac arrest should be systematic. In the present review, we sought to describe the potential benefit of intracoronary imaging in patients with out-of-hospital cardiac arrest.
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Affiliation(s)
- Pierre Brami
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France
| | - Gabriel Seret
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Quentin Fischer
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Vincent Pham
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France; Centre d'expertise sur la mort subite (CEMS), 75015 Paris, France.
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4
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Comparative Outcomes After Percutaneous Coronary Intervention in Unconscious and Conscious Patients After Out-of-Hospital Cardiac Arrest. JACC Cardiovasc Interv 2022; 15:1338-1348. [DOI: 10.1016/j.jcin.2022.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 01/27/2023]
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5
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Coronary angiography in patients after cardiac arrest without ST-elevation myocardial infarction : A retrospective cohort analysis. Wien Klin Wochenschr 2021; 133:762-769. [PMID: 34191110 PMCID: PMC8373755 DOI: 10.1007/s00508-021-01899-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
Background Coronary artery disease (CAD) is the most common cause of sudden cardiac arrest (SCA). Although coronary angiography (CAG) should be performed also in the absence of ST-elevation (STE) after sustained return of spontaneous circulation (ROSC), this recommendation is not well implemented in daily routine. Methods A retrospective database analysis was conducted in a tertiary care center between January 2005 and December 2014. We included all SCA patients aged ≥ 18 years with presumed cardiac cause and sustained ROSC in the absence of STE at hospital admission. The rate and timing of CAG were defined as the primary endpoints. As secondary endpoints, the reasons pro and contra CAG were analyzed. Furthermore, we observed if the signs and symptoms used for decision making occurred more often in patients with treatable CAD. Results We included 645 (53.6%) of the 1203 screened patients, CAG was performed in 343 (53.2%) patients with a diagnosis of occlusive CAD in 214 (62.4%) patients. Of these, 151 (71.0%) patients had occlusive CAD treated with coronary intervention, thrombus aspiration, or coronary artery bypass grafting. In an adjusted binomial logistic regression analysis, age ≥ 70 years, female sex, non-shockable rhythms, and cardiomyopathy were associated with withholding of CAG. In patients diagnosed and treated with occlusive CAD, initially shockable rhythms, previously diagnosed CAD, hypertension, and smoking were found more often. Conclusion Although selection bias is unavoidable due to the retrospective design of this study, a high proportion of the examined patients had occlusive CAD. The criteria used for patient selection may be suboptimal.
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6
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McFadden P, Reynolds JC, Madder RD, Brown M. Diagnostic test accuracy of the initial electrocardiogram after resuscitation from cardiac arrest to indicate invasive coronary angiographic findings and attempted revascularization: A systematic review and meta-analysis. Resuscitation 2021; 160:20-36. [PMID: 33444708 DOI: 10.1016/j.resuscitation.2020.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023]
Abstract
AIM Conduct a diagnostic test accuracy systematic review and meta-analysis of the post-return of spontaneous circulation (ROSC) electrocardiogram (ECG) to indicate an acute-appearing coronary lesion and revascularization. METHODS We searched PubMed, EMBASE, CINAHL, Cochrane Library, and Web of Science through February 18, 2020. Two investigators screened titles and abstracts, extracted data, and assessed risks of bias using QUADAS-2. We estimated sensitivity (Sn), specificity (Sp), and likelihood ratios (LR) for all reported ECG features to indicate all reported reference standards. Random-effects meta-analysis pooled comparable studies without critical risk of bias. GRADE methodology evaluated the certainty of evidence. RESULTS Overall, 48 studies reported 94 combinations of ECG features and reference standards with wide variation in their definitions. Most studies had risks of bias from selection for coronary angiography and blinding to the ECG and/or reference standard. Meta-analysis combined 6 studies for STE and acute coronary lesion (Sn 0.70 [95% CI 0.54-0.82]; Sp 0.85 [95% CI 0.78-0.90]; LR + 4.7 [95% CI 3.3-6.7]; LR- 0.4 [95% CI 0.2-0.6]) and 4 studies for STE and revascularization (Sn 0.53 [95% CI 0.47-0.58]; Sp 0.86 [95% CI 0.80-0.91]; LR + 3.9 [95% CI 2.8-5.5]; LR- 0.5 [95% CI 0.5-0.6]). Overall certainty of evidence was low with substantial heterogeneity. CONCLUSIONS Based on low certainty evidence, STE had good classification for acute coronary lesion and fair classification for revascularization. STE was more specific than sensitive for these outcomes and no single ECG feature excluded them. Uniform definitions and terminology would greatly facilitate the interpretation of subsequent studies.
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Affiliation(s)
- Patrick McFadden
- Spectrum Health Department of Emergency Medicine, Grand Rapids, MI, USA
| | - Joshua C Reynolds
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan Street NE, Suite 736D, Grand Rapids, MI 49503, USA.
| | - Ryan D Madder
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
| | - Michael Brown
- Michigan State University College of Human Medicine, Department of Emergency Medicine, 15 Michigan Street NE, Suite 736D, Grand Rapids, MI 49503, USA
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Wittwer MR, Zeitz C, Wu S, Mishra K, Rajendran S, Beltrame JF, Arstall MA. Cardiologists appropriately exclude resuscitated out-of-hospital cardiac arrests from emergency coronary angiography. J Am Coll Emerg Physicians Open 2020; 1:1177-1184. [PMID: 33392520 PMCID: PMC7771780 DOI: 10.1002/emp2.12276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Emergency coronary angiography after resuscitated out-of-hospital cardiac arrest as a selective or non-selective diagnostic procedure with or without intervention continues to be the subject of debate. This study sought to determine if cardiologists reliably select patients using clinical judgement for emergency coronary angiography without missing acutely ischemic cases requiring revascularization. METHODS Presenting clinical details and ECGs (within 2 hours) from 52 consecutive out-of-hospital cardiac arrest patients who underwent non-selective coronary angiography were compiled retrospectively. Three out-of-hospital cardiac arrest-experienced interventional cardiologists, blinded to patient outcome, independently determined working diagnosis, and decision for emergency coronary angiography using clinical judgement. Sensitivity of the cardiologists' decision was assessed with respect to the outcome of acute revascularization. Inter-rater differences, consensus in clinical assessment, and influence of working diagnosis were also investigated. RESULTS Sensitivity of individual cardiologist's decision for emergency coronary angiography with respect to acute revascularization was very high (adjusted overall sensitivity = 95.8%, 95% CI = 89-100, cardiologist range = 93%-100%), and perfect for the consensus of 2 or more cardiologists (100%, 95% CI = 79.4-100). There was no statistical difference in the sensitivity of this decision between cardiologists (P < 0.05), and inter-rater agreement was moderate (78% overall agreement, Κ = 0.56). CONCLUSIONS Experienced cardiologists recommend emergency coronary angiography in all resuscitated out-of-hospital cardiac arrest requiring acute revascularization and appropriately excluded one-third of patients. Rather than advocating a non-selective, or conversely, a restrictive strategy with respect to coronary angiography after out-of-hospital cardiac arrest, the findings support an individualized approach by a multidisciplinary emergency team that includes experienced cardiologists. The results should be confirmed in a larger prospective study.
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Affiliation(s)
- Melanie R. Wittwer
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Cardiology UnitLyell McEwin and Modbury Hospitals, Northern Adelaide Local Health NetworkElizabeth ValeSouth AustraliaAustralia
| | - Chris Zeitz
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Cardiology UnitThe Queen Elizabeth and Royal Adelaide Hospitals, Central Adelaide Local Health NetworkWoodville SouthSouth AustraliaAustralia
| | - Sunny Wu
- Princess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | - Kumaril Mishra
- Cardiology UnitLyell McEwin and Modbury Hospitals, Northern Adelaide Local Health NetworkElizabeth ValeSouth AustraliaAustralia
| | - Sharmalar Rajendran
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Cardiology UnitLyell McEwin and Modbury Hospitals, Northern Adelaide Local Health NetworkElizabeth ValeSouth AustraliaAustralia
| | - John F. Beltrame
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Cardiology UnitThe Queen Elizabeth and Royal Adelaide Hospitals, Central Adelaide Local Health NetworkWoodville SouthSouth AustraliaAustralia
| | - Margaret A. Arstall
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Cardiology UnitLyell McEwin and Modbury Hospitals, Northern Adelaide Local Health NetworkElizabeth ValeSouth AustraliaAustralia
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8
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Hochstrasser SR, Metzger K, Vincent AM, Becker C, Keller AKJ, Beck K, Perrig S, Tisljar K, Sutter R, Schuetz P, Bernasconi L, Neyer P, Marsch S, Hunziker S. Trimethylamine-N-oxide (TMAO) predicts short- and long-term mortality and poor neurological outcome in out-of-hospital cardiac arrest patients. Clin Chem Lab Med 2020; 59:393-402. [PMID: 32866111 DOI: 10.1515/cclm-2020-0159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022]
Abstract
Objectives Prior research found the gut microbiota-dependent and pro-atherogenic molecule trimethylamine-N-oxide (TMAO) to be associated with cardiovascular events as well as all-cause mortality in different patient populations with cardiovascular disease. Our aim was to investigate the prognostic value of TMAO regarding clinical outcomes in patients after out-of-hospital cardiac arrest (OHCA). Methods We included consecutive OHCA patients upon intensive care unit admission into this prospective observational study between October 2012 and May 2016. We studied associations of admission serum TMAO with in-hospital mortality (primary endpoint), 90-day mortality and neurological outcome defined by the Cerebral Performance Category (CPC) scale. Results We included 258 OHCA patients of which 44.6% died during hospitalization. Hospital non-survivors showed significantly higher admission TMAO levels (μmol L-1) compared to hospital survivors (median interquartile range (IQR) 13.2 (6.6-34.9) vs. 6.4 (2.9-15.9), p<0.001). After multivariate adjustment for other prognostic factors, TMAO levels were significantly associated with in-hospital mortality (adjusted odds ratios (OR) 2.1, 95%CI 1.1-4.2, p=0.026). Results for secondary outcomes were similar with significant associations with 90-day mortality and neurological outcome in univariate analyses. Conclusions In patients after OHCA, TMAO levels were independently associated with in-hospital mortality and other adverse clinical outcomes and may help to improve prognostication for these patients in the future. Whether TMAO levels can be influenced by nutritional interventions should be addressed in future studies.
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Affiliation(s)
- Seraina R Hochstrasser
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Kerstin Metzger
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Alessia M Vincent
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Annalena K J Keller
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Katharina Beck
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Sebastian Perrig
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Kai Tisljar
- Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Philipp Schuetz
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Kantonsspital Aarau, Department of Internal Medicine, Aarau, Switzerland
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Peter Neyer
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Marsch
- Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Sabina Hunziker
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
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9
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Abstract
Cardiac arrest (CA) results in multiorgan ischemia until return of spontaneous circulation and often is followed by a low-flow shock state. Upon restoration of circulation and organ perfusion, resuscitative teams must act quickly to achieve clinical stability while simultaneously addressing the underlying etiology of the initial event. Optimal cardiovascular care demands focused management of the post-cardiac arrest syndrome and associated shock. Acute coronary syndrome should be considered and managed in a timely manner, because early revascularization improves patient outcomes and may suppress refractory arrhythmias. This review outlines the diagnostic and therapeutic considerations that define optimal cardiovascular care after CA.
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Affiliation(s)
- Barry Burstein
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jacob C Jentzer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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10
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Elfwén L, Lagedal R, Rubertsson S, James S, Oldgren J, Olsson J, Hollenberg J, Jensen U, Ringh M, Svensson L, Nordberg P. Post-resuscitation myocardial dysfunction in out-of-hospital cardiac arrest patients randomized to immediate coronary angiography versus standard of care. IJC HEART & VASCULATURE 2020; 27:100483. [PMID: 32154359 PMCID: PMC7056719 DOI: 10.1016/j.ijcha.2020.100483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/30/2022]
Abstract
Background Immediate coronary angiography with subsequent percutaneous coronary intervention (PCI) has the potential to reduce post-resuscitation myocardial dysfunction in out-of-hospital cardiac arrest (OHCA) patients. The aim of this study was to see if immediate coronary angiography, with potential PCI, in patients without ST-elevation on the ECG, influenced post-resuscitation myocardial function and cardiac biomarkers. Methods A secondary analysis of the Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest (DISCO) trial (ClinicalTrials.gov ID: NCT02309151). Patients with bystander-witnessed OHCA, without ST-elevations on the ECG were randomly assigned to immediate coronary angiography within two hours of cardiac arrest (n = 38) versus standard-of-care with deferred angiography (n = 40). Outcome measures included left ventricle ejection fraction (LVEF) at 24 h, peak Troponin T levels, lactate clearance and NT-proBNP at 72 h. Results In the immediate-angiography group, median LVEF at 24 h was 47% (Q1-Q3; 30–55) vs. 46% (Q1-Q3; 35–55) in the standard-of-care group. Peak Troponin-T levels during the first 24 h were 362 ng/L (Q1-Q3; 174–2020) in the immediate angiography group and 377 ng/L (Q1-Q3; 205–1078) in the standard-of-care group. NT-proBNP levels at 72 h were 931 ng/L (Q1-Q3; 396–2845) in the immediate-angiography group and 1913 ng/L (Q1-Q3; 489–3140) in the standard-of-care group. Conclusion In this analysis of OHCA patients without ST-elevation on the ECG randomized to immediate coronary angiography or standard-of-care, no differences in post-resuscitation myocardial dysfunction parameters between the two groups were found. This finding was consistent also in patients randomized to immediate coronary angiography where PCI was performed compared to those where PCI was not performed.
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Affiliation(s)
- Ludvig Elfwén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden
| | - Rickard Lagedal
- Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | - Sten Rubertsson
- Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | - Stefan James
- Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Sweden
| | - Jonas Oldgren
- Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Sweden
| | - Jens Olsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden
| | - Jacob Hollenberg
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden
| | - Ulf Jensen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden
| | - Mattias Ringh
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden
| | - Leif Svensson
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden
| | - Per Nordberg
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden
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11
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Matsumura K, Otagaki M, Fujii K, Shibutani H, Morishita S, Hashimoto K, Tsujimoto S, Yamamoto Y, Sugiura T, Shiojima I. Coronary artery calcification as a novel predictive marker of unstable coronary lesion in survivors of out-of-hospital cardiac arrest without ST-segment elevation. Resuscitation 2019; 147:67-72. [PMID: 31901459 DOI: 10.1016/j.resuscitation.2019.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/10/2019] [Accepted: 12/19/2019] [Indexed: 01/09/2023]
Abstract
AIM Acute myocardial infarction (AMI) is the leading cause of out-of-hospital cardiac arrest (OHCA). A highly predictive marker is needed to identify AMI in survivors of OHCA without ST-segment elevation because the appropriate indication for emergency coronary artery angiography in patients without ST-segment segment elevation has not been determined. Accordingly, the aim of this study was to elucidate the clinical significance of coronary artery calcification in identifying survivors of OHCA without ST-segment elevation who could benefit from emergency coronary artery angiography. METHODS Survivors of OHCA without ST-segment elevation with no obvious extra-cardiac cause who underwent emergency computed tomography and coronary artery angiography were enrolled. Unstable coronary lesion was diagnosed using coronary artery angiography, and presence of coronary artery calcification and coronary artery calcium score were evaluated by non-contrast, non-electrocardiography gated computed tomography. RESULTS Thirty of 100 consecutive survivors of OHCA were diagnosed to have unstable coronary lesion. Sensitivity and specificity of coronary artery calcification in identifying unstable coronary lesion were 87% and 60%, respectively. Multivariate logistic regression analysis revealed that coronary artery calcification was an independent predictor of unstable coronary lesion (odds ratio: 7.28, 95% confidence interval: 2.00-26.56, p < 0.001). CONCLUSION Evaluation of coronary artery calcification by computed tomography is useful in identifying patients with unstable coronary lesion who could benefit from emergency coronary artery angiography among survivors of OHCA without ST-segment elevation on post-resuscitation electrocardiography.
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Affiliation(s)
- Koichiro Matsumura
- Department of Cardiology, Kansai Medical University Medical Center, Moriguchi, Japan.
| | - Munemitsu Otagaki
- Department of Cardiology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Kenichi Fujii
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Hiroki Shibutani
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Shun Morishita
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Kenta Hashimoto
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Satoshi Tsujimoto
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Yoshihiro Yamamoto
- Department of Cardiology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Tetsuro Sugiura
- Department of Cardiology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Ichiro Shiojima
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
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The quest continues to identify coronary occlusion in OHCA without ST elevation. Resuscitation 2019; 146:258-260. [PMID: 31682899 DOI: 10.1016/j.resuscitation.2019.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/17/2022]
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13
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Berden J, Steblovnik K, Noc M. Mechanism and extent of myocardial injury associated with out-of-hospital cardiac arrest. Resuscitation 2019; 138:1-7. [DOI: 10.1016/j.resuscitation.2019.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 11/16/2022]
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14
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Bougouin W, Piazza O, Dumas F, Baldi C, Cariou A, De Robertis E. Coronary angiogram after cardiac arrest? Reasonably and sensibly. Minerva Anestesiol 2019; 85:554-558. [DOI: 10.23736/s0375-9393.19.13425-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Spaulding C. Indications et heure de la coronarographie après un arrêt cardiaque extrahospitalier sans cause extracardiaque évidente. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2018-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les lésions coronaires instables sont la première cause des arrêts cardiaques extrahospitaliers. L’angioplastie coronaire semble améliorer la survie de ces patients. En l’absence de données randomisées, les recommandations actuelles sont fondées sur des données de registre. Une coronarographie immédiate, dès l’admission du patient, est recommandée s’il existe un sus-décalage du segment ST sur l’électrocardiogramme réalisé après retour d’une activité circulatoire spontanée. Dans les autres cas, il est conseillé de rechercher en premier une cause extracardiaque, notamment par la réalisation d’un scanner cérébral et thoracique. Si aucune cause extracardiaque n’a été retrouvée, la coronarographie doit être réalisée rapidement, moins de deux heures après l’admission. Si une lésion coronaire responsable de l’arrêt peut être identifiée, une angioplastie est réalisée au mieux par voie radiale et en utilisant des endoprothèses actives. Une nouvelle coronarographie à distance peut être indiquée chez les survivants pour réaliser une revascularisation complémentaire ou pour rechercher un spasme coronaire chez les patients dont la première coronarographie était normale.
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16
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Usefulness of early plasma S-100B protein and Neuron-Specific Enolase measurements to identify cerebrovascular etiology of out-of-hospital cardiac arrest. Resuscitation 2018; 130:61-66. [DOI: 10.1016/j.resuscitation.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/21/2018] [Accepted: 07/04/2018] [Indexed: 11/21/2022]
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17
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Isenschmid C, Kalt J, Gamp M, Tondorf T, Becker C, Tisljar K, Locher S, Schuetz P, Marsch S, Hunziker S. Routine blood markers from different biological pathways improve early risk stratification in cardiac arrest patients: Results from the prospective, observational COMMUNICATE study. Resuscitation 2018; 130:138-145. [PMID: 30036589 DOI: 10.1016/j.resuscitation.2018.07.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/27/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Prognostication of cardiac arrest patients admitted to the intensive care unit (ICU) may influence treatment decision, but remains challenging. We evaluated the incremental usefulness of routine blood markers from different biological pathways for predicting fatal outcome and neurological deficits in cardiac arrest patients. METHODS We prospectively included consecutive, adult cardiac arrest patients upon ICU admission. We recorded initial clinical parameters and measured blood markers of cardiac injury/stress (troponin, BNP, CK), inflammation/infection (WBC, CRP, procalcitonin) and shock (lactate, creatinine, urea). The primary and secondary endpoints were all-cause in-hospital mortality and bad neurological outcome defined by the Cerebral Performance Category (CPC) score. RESULTS Mortality in the 321 included patients was 49% (n = 156). Procalcitonin (adjusted odds ratio 1.84, 95%CI 1.34 to 2.53, p < 0.001; AUC 0.73) and lactate (adjusted odds ratio 7.29, 95%CI 3.05 to 17.42, p < 0.001; AUC 0.70) were identified as independent prognostic factors for mortality and significantly improved discrimination of a parsimonious clinical model including resuscitation measures (no-flow time, shockable rhythm) and initial vital signs (Glasgow coma scale, respiratory rate) from an AUC of 0.79 to 0.84 (p < 0.001). Cardiac markers did not further improve the model. Results for neurological outcome were similar with model improvements by procalcitonin and lactate from AUC 0.83 to 0.87 (p = 0.004). CONCLUSION Assessment of routine markers of inflammation/infection and shock provide significant improvements for prognostication of cardiac arrest patients, while cardiac markers did not further improve statistical models. Combination of blood markers and clinical parameters may help to improve initial management decisions in this vulnerable patient population.
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Affiliation(s)
- Cyril Isenschmid
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Jeanice Kalt
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Martina Gamp
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Theresa Tondorf
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Kai Tisljar
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland
| | - Stefan Locher
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Philipp Schuetz
- Medical Faculty of the University of Basel, Switzerland; Department of Internal Medicine, Kantonsspital Aarau, Switzerland
| | - Stephan Marsch
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Sabina Hunziker
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland; Medical Faculty of the University of Basel, Switzerland.
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Welsford M, Bossard M, Shortt C, Pritchard J, Natarajan MK, Belley-Côté EP. Does Early Coronary Angiography Improve Survival After out-of-Hospital Cardiac Arrest? A Systematic Review With Meta-Analysis. Can J Cardiol 2018; 34:180-194. [PMID: 29275998 DOI: 10.1016/j.cjca.2017.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In patients with out-of-hospital cardiac arrest who achieve return of spontaneous circulation, coronary angiography (CAG) might improve outcomes. We conducted a systematic review and meta-analysis to elucidate the benefit and optimal timing of early CAG in comatose out-of-hospital cardiac arrest patients with return of spontaneous circulation. METHODS We searched MEDLINE, EMBASE, and Cochrane from 1990 to May 2017. Studies reporting survival and/or neurological survival in early (< 24-hour) vs late/no CAG were selected. We used the Clinical Advances Through Research and Information Translation (CLARITY) risk of bias in cohort studies tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria to assess risk of bias and quality of evidence, respectively. Results were pooled using random effects and presented as risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS After screening 9185 titles/abstracts and 631 full-text articles, we included 23 nonrandomized studies. Short (to discharge or 30 days) and long-term (1-5 years) survival were significantly improved (52% and 56%, respectively) in the early < 24-hour CAG group compared with the late/no CAG group (RR, 1.52; 95% CI, 1.32-1.74; P < 0.00001; I2, 94% and RR, 1.56; 95% CI, 1.14-2.14; P = 0.006; I2, 86%). Survival with good neurological outcome was also improved by 69% in the < 24-hour CAG group at short- (RR, 1.69; 95% CI, 1.40-2.04; P < 0.00001; I2, 93%) and intermediate-term (3-11 months; RR, 1.49; 95% CI, 1.27-1.76; P < 0.00001; I2, 67%). We found consistent benefits in the < 2-hour and < 6-hour subgroups. Early CAG was associated with significantly better outcomes in studies of patients without ST-elevation, but the results did not reach statistical significance in studies of patients with ST-elevation. CONCLUSIONS On the basis of very low quality, but consistent evidence, early CAG (< 24 hours) was associated with significantly higher survival and better neurologic outcomes.
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Affiliation(s)
- Michelle Welsford
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada; Centre for Paramedic Education and Research, Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | - Matthias Bossard
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Cardiology Division, Heart Centre, Luzerner Kantonsspital, Luzern, Switzerland
| | - Colleen Shortt
- Centre for Paramedic Education and Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jodie Pritchard
- Emergency Medicine Residency Program, McMaster University, Hamilton, Ontario, Canada
| | - Madhu K Natarajan
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Emilie P Belley-Côté
- Emergency Medicine Residency Program, McMaster University, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
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Should We Perform an Immediate Coronary Angiogram in All Patients After Cardiac Arrest? JACC Cardiovasc Interv 2018; 11:249-256. [DOI: 10.1016/j.jcin.2017.09.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/25/2017] [Accepted: 09/13/2017] [Indexed: 11/20/2022]
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20
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High-Sensitivity Troponin as a Biomarker in Heart Rhythm Disease. Am J Cardiol 2017; 119:1407-1413. [PMID: 28256250 DOI: 10.1016/j.amjcard.2017.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/23/2022]
Abstract
Biomarkers are important prognostic tools in various cardiovascular conditions, including coronary artery disease and heart failure. Although their utility in cardiac electrophysiology (EP) is less established, biomarkers may guide EP clinical practice by identifying patients at risk for developing arrhythmias and their complications, in addition to augmenting therapeutic decisions by targeting appropriate pharmacologic and interventional therapies to patients who may benefit most. In this review, we focus on the prognostic role of high-sensitivity cardiac troponin (hs-cTn) assays-which detect subclinical cardiac myocyte damage-in cardiac arrhythmias and their sequelae. We review the current literature on hs-cTn and its impact on various arrhythmia disease states and also provide suggestions for future research in this field. In conclusion, although the utility of hs-cTn assays remains at an investigational stage in cardiac EP, studies to date have suggested value as a prognostic biomarker in atrial fibrillation and as a screening marker for patients at high risk of sudden cardiac death (both in the general population and among those with hypertrophic cardiomyopathy).
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21
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Zeyons F, Jesel L, Morel O, Kremer H, Messas N, Hess S, Crimizade U, Reydel P, Tritsch L, Ohlmann P. Out-of-hospital cardiac arrest survivors sent for emergency angiography: a clinical score for predicting acute myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:103-111. [PMID: 28304194 DOI: 10.1177/2048872616683525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) remains a major public health issue. Emergency coronary angiography and percutaneous coronary intervention might improve survival, especially when cardiac arrest is caused by acute myocardial infarction (AMI). However, identifying patients with AMI after OHCA remains challenging. The aim of this study was to determine the clinical and ECG criteria in OHCA that may help to identify better the patients with AMI. METHODS Consecutive OHCA patients who underwent emergency coronary angiography in our centre between 2009 and 2013 were included in this retrospective single-centre observational study. RESULTS A total of 177 patients with complete datasets were included. Significant coronary artery disease was found in 71% of the patients, and 43% presented with AMI. The independent predictors of AMI were ST elevation in any lead including aVR (odds ratio (OR) 18.06; 95% confidence interval (CI) 6.6-49.38), chest pain before cardiac arrest (OR 4.05; 95% CI 1.55-10.54) and an initial shockable rhythm (OR 2.99; 95% CI 1.34-6.45). An additive score that included these three predictors yielded a sensitivity and a specificity for detecting AMI of 93% and 63%, respectively. CONCLUSIONS These data suggest that fewer than half of patients with OHCA undergoing emergency coronary angiography present with AMI. The identification of OHCA patients with AMI might be improved by a simple score using post-resuscitation ECG and simple clinical criteria.
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Affiliation(s)
- Floriane Zeyons
- 1 Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, France
| | - Laurence Jesel
- 1 Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, France
| | - Olivier Morel
- 1 Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, France
| | - Hélène Kremer
- 1 Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, France
| | - Nathan Messas
- 1 Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, France
| | - Sebastien Hess
- 1 Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, France
| | - Ulun Crimizade
- 1 Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, France
| | | | | | - Patrick Ohlmann
- 1 Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, France
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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 2016; 111:82-89. [PMID: 27988273 DOI: 10.1016/j.resuscitation.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 11/30/2016] [Accepted: 12/04/2016] [Indexed: 11/22/2022]
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.
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Gilje P, Koul S, Thomsen JH, Devaux Y, Friberg H, Kuiper M, Horn J, Nielsen N, Pellis T, Stammet P, Wise MP, Kjaergaard J, Hassager C, Erlinge D. High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest – A targeted temperature management (TTM) trial substudy. Resuscitation 2016; 107:156-61. [DOI: 10.1016/j.resuscitation.2016.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/23/2016] [Accepted: 06/20/2016] [Indexed: 01/25/2023]
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Geri G, Dumas F, Bougouin W, Varenne O, Daviaud F, Pène F, Lamhaut L, Chiche JD, Spaulding C, Mira JP, Empana JP, Cariou A. Immediate Percutaneous Coronary Intervention Is Associated With Improved Short- and Long-Term Survival After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv 2016; 8:CIRCINTERVENTIONS.114.002303. [PMID: 26453685 DOI: 10.1161/circinterventions.114.002303] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Whether to perform or not an immediate percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest is still debated. We aimed to evaluate the impact of PCI on short- and long-term survival in out-of-hospital cardiac arrest patients admitted after successful resuscitation. METHODS AND RESULTS Between 2000 and 2013, all nontrauma out-of-hospital cardiac arrest patients admitted in a Parisian cardiac arrest center after return of spontaneous circulation were prospectively included. The association between immediate PCI and short- and long-term mortality was analyzed using logistic regression and Cox multivariate analysis, respectively. Propensity score-matching method was used to assess the influence of PCI on short- and long-term survival. During the study period, 1722 patients (71.5% male, median age 60 [49.6, 72.2] years) were analyzed: 628 (35.6%) without coronary angiography, 615 (35.7%) with coronary angiography without PCI, and 479 (27.8%) with both. Among these groups, day 30 and year-10 survival rates were 21% and 11.9%, 35% and 29%, 43% and 38%, respectively (P<0.01 for each). PCI as compared with no coronary angiography was associated with a lower day-30 and long-term mortality (adjORcoro with PCI versus no coro 0.71, 95% confidence interval [0.54, 0.92]; P=0.02 and adjHRcoro with PCI versus no coro 0.44, 95% confidence interval [0.27, 0.71]; P<0.01, respectively). PCI remained associated with a lower risk of long-term mortality (adjHR 0.29; 95% confidence interval [0.14, 0.61]; P<0.01) in propensity score-matching analysis. CONCLUSIONS Immediate PCI after out-of-hospital cardiac arrest was associated with significant reduced risk of short- and long-term mortality. These findings should suggest physicians to consider immediate coronary angiography and PCI if indicated in these patients.
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Affiliation(s)
- Guillaume Geri
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Florence Dumas
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Wulfran Bougouin
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Olivier Varenne
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Fabrice Daviaud
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Frédéric Pène
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Lionel Lamhaut
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Jean-Daniel Chiche
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Christian Spaulding
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Jean-Paul Mira
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Jean-Philippe Empana
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.)
| | - Alain Cariou
- From the Medical Intensive Care Unit (G.G., W.B., F. Daviaud, F.P., J.-D.C., J.-P.M., A.C.), Emergency Department (F. Dumas), and Cardiology Department (O.V.), Cochin Hospital, Assistance Publique Hôpitaux de Paris; Emergency Medical Service, SAMU 75 (L.L.); INSERM, UMR-S970, Paris Cardiovascular Research Centre, Department of Epidemiology, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (G.G., F. Dumas, W.B., O.V., F. Daviaud, F.P., L.L., J.-D.C., C.S., J.-P.M., J.-P.E., A.C.); Sudden Death Expertise Center, Paris, France (G.G., F. Dumas, W.B., L.L., C.S., J.-P.E., A.C.); and Cardiology Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris (C.S.).
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Geri G, Cariou A. Syndrome post-arrêt cardiaque. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pearson DA, Wares CM, Mayer KA, Runyon MS, Studnek JR, Ward SL, Kraft KM, Heffner AC. Troponin Marker for Acute Coronary Occlusion and Patient Outcome Following Cardiac Arrest. West J Emerg Med 2015; 16:1007-13. [PMID: 26759645 PMCID: PMC4703178 DOI: 10.5811/westjem.2015.10.28346] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/05/2015] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The utility of troponin as a marker for acute coronary occlusion and patient outcome after out-of-hospital cardiac arrest (OHCA) is unclear. We sought to determine whether initial or peak troponin was associated with percutaneous coronary intervention (PCI), OHCA survival or neurological outcome. METHODS Single-center retrospective-cohort study of OHCA patients treated in a comprehensive clinical pathway from November 2007 to October 2012. Troponin I levels were acquired at presentation, four and eight hours after arrest, and then per physician discretion. Cardiac catheterization was at the cardiologist's discretion. Survival and outcome were determined at hospital discharge, with cerebral performance category score 1-2 defined as a good neurological outcome. RESULTS We enrolled 277 patients; 58% had a shockable rhythm, 44% survived, 41% good neurological outcome. Of the 107 (38%) patients who underwent cardiac catheterization, 30 (28%) had PCI. Initial ED troponin (median, ng/mL) was not different in patients requiring PCI vs no PCI (0.32 vs 0.09, p=0.06), although peak troponin was higher (4.19 versus 1.57, p=0.02). Of the 85 patients who underwent cardiac catheterization without STEMI (n=85), there was no difference in those who received PCI vs no PCI in initial troponin (0.22 vs 0.06, p=0.40) or peak troponin (2.58 vs 1.43, p=0.27). Regarding outcomes, there was no difference in initial troponin in survivors versus non-survivors (0.09 vs 0.22, p=0.11), or those with a good versus poor neurological outcome (0.09 vs 0.20, p=0.11). Likewise, there was no difference in peak troponin in survivors versus non-survivors (1.64 vs 1.23, p=0.07), or in those with a good versus poor neurological outcome (1.57 vs 1.26, p=0.14). CONCLUSION In our single-center patient cohort, peak troponin, but not initial troponin, was associated with higher likelihood of PCI, while neither initial nor peak troponin were associated with survival or neurological outcome in OHCA patients.
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Affiliation(s)
- David A Pearson
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina
| | - Catherine M Wares
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina
| | - Katherine A Mayer
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina
| | - Michael S Runyon
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina
| | | | - Shana L Ward
- Carolinas Health Care System, Dickson Advanced Analytics Group, Charlotte, North Carolina
| | - Kathi M Kraft
- Carolinas Health Care System, Dickson Advanced Analytics Group, Charlotte, North Carolina
| | - Alan C Heffner
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina; Carolinas Medical Center, Department of Internal Medicine, Division of Critical Care Medicine, Charlotte, North Carolina
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Impact of urgent coronary angiography on mid-term clinical outcome of comatose out-of-hospital cardiac arrest survivors presenting without ST-segment elevation. Resuscitation 2015; 94:61-6. [DOI: 10.1016/j.resuscitation.2015.06.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/23/2015] [Accepted: 06/29/2015] [Indexed: 11/18/2022]
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Salam I, Hassager C, Thomsen JH, Langkjær S, Søholm H, Bro-Jeppesen J, Bang L, Holmvang L, Erlinge D, Wanscher M, Lippert FK, Køber L, Kjaergaard J. Editor’s Choice-Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction? EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:317-26. [DOI: 10.1177/2048872615585519] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/08/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Idrees Salam
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Christian Hassager
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Sandra Langkjær
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Helle Søholm
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lia Bang
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lene Holmvang
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Sweden
| | - Michael Wanscher
- Department of Cardiothoracic Anaesthesia 4142, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | - Lars Køber
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
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Karlsson V, Dankiewicz J, Nielsen N, Kern KB, Mooney MR, Riker RR, Rubertsson S, Seder DB, Stammet P, Sunde K, Søreide E, Unger BT, Friberg H. Association of gender to outcome after out-of-hospital cardiac arrest--a report from the International Cardiac Arrest Registry. Crit Care 2015; 19:182. [PMID: 25895673 PMCID: PMC4426639 DOI: 10.1186/s13054-015-0904-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/30/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Previous studies have suggested an effect of gender on outcome after out-of-hospital cardiac arrest (OHCA), but the results are conflicting. We aimed to investigate the association of gender to outcome, coronary angiography (CAG) and adverse events in OHCA survivors treated with mild induced hypothermia (MIH). Methods We performed a retrospective analysis of prospectively collected data from the International Cardiac Arrest Registry. Adult patients with a non-traumatic OHCA and treated with MIH were included. Good neurological outcome was defined as a cerebral performance category (CPC) of 1 or 2. Results A total of 1,667 patients, 472 women (28%) and 1,195 men (72%), met the inclusion criteria. Men were more likely to receive bystander cardiopulmonary resuscitation, have an initial shockable rhythm and to have a presumed cardiac cause of arrest. At hospital discharge, men had a higher survival rate (52% vs. 38%, P <0.001) and more often a good neurological outcome (43% vs. 32%, P <0.001) in the univariate analysis. When adjusting for baseline characteristics, male gender was associated with improved survival (OR 1.34, 95% CI 1.01 to 1.78) but no longer with neurological outcome (OR 1.24, 95% CI 0.92 to 1.67). Adverse events were common; women more often had hypokalemia, hypomagnesemia and bleeding requiring transfusion, while men had more pneumonia. In a subgroup analysis of patients with a presumed cardiac cause of arrest (n = 1,361), men more often had CAG performed on admission (58% vs. 50%, P = 0.02) but this discrepancy disappeared in an adjusted analysis. Conclusions Gender differences exist regarding cause of arrest, adverse events and outcome. Male gender was independently associated with survival but not with neurological outcome.
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Affiliation(s)
- Viktor Karlsson
- Department of Clinical Sciences, Lund University, 22184, Lund, Sweden.
| | - Josef Dankiewicz
- Department of Clinical Sciences, Lund University, 22184, Lund, Sweden. .,Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Lund, 22185, Sweden.
| | - Niklas Nielsen
- Department of Clinical Sciences, Lund University, 22184, Lund, Sweden. .,Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, 25187, Helsingborg, Sweden.
| | - Karl B Kern
- Sarver Heart Center, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.
| | - Michael R Mooney
- Minneapolis Heart Institute Foundation, Abbot Northwestern Hospital, 920 E 28th Street 100, Minneapolis, MN, 55407, USA.
| | - Richard R Riker
- Department of Critical Care Services and Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
| | - Sten Rubertsson
- Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Akademiska sjukhuset, 75185, Uppsala, Sweden.
| | - David B Seder
- Department of Critical Care Services and Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
| | - Pascal Stammet
- Department of Anesthesia and Intensive Care, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210, Luxembourg, Luxembourg.
| | - Kjetil Sunde
- Department of Anaesthesiology, Surgical ICU Ullevål, Oslo University Hospital, Oslo, Norway.
| | - Eldar Søreide
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, 4068, Stavanger, Norway. .,Department of Clinical Medicine, University of Bergen, Jonas Lies veg 87, 5021, Bergen, Norway.
| | - Barbara T Unger
- Minneapolis Heart Institute Foundation, Abbot Northwestern Hospital, 920 E 28th Street 100, Minneapolis, MN, 55407, USA.
| | - Hans Friberg
- Department of Clinical Sciences, Lund University, 22184, Lund, Sweden. .,Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Lund, 22185, Sweden.
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Røsjø H, Vaahersalo J, Hagve TA, Pettilä V, Kurola J, Omland T. 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. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:605. [PMID: 25490117 PMCID: PMC4256726 DOI: 10.1186/s13054-014-0605-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 10/20/2014] [Indexed: 11/19/2022]
Abstract
Introduction Myocardial 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. Methods A 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. Results Admission 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. Conclusion hs-TnT levels are elevated in critically ill patients with OHCA-VF/VT, but do not improve risk prediction.
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