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

• Published in: Journal of the Society for Cardiovascular Angiography & Interventions 2024-02, Vol.3 (2), p.101191, Article 101191
• Main Authors: Spoormans, Eva M., Lemkes, Jorrit S., Janssens, Gladys N., van der Hoeven, Nina W., Jewbali, Lucia S.D., Dubois, Eric A., Meuwissen, Martijn, Rijpstra, Tom A., Bosker, Hans A., Blans, Michiel J., Bleeker, Gabe B., Baak, Remon, Vlachojannis, Georgios J., Eikemans, Bob J.W., van der Harst, Pim, van der Horst, Iwan C.C., Voskuil, Michiel, van der Heijden, Joris J., Beishuizen, Albertus, Stoel, Martin, Camaro, Cyril, van der Hoeven, Hans, Henriques, José P., Vlaar, Alexander P.J., Vink, Maarten A., van den Bogaard, Bas, Heestermans, Ton A.C.M., de Ruijter, Wouter, Delnoij, Thijs S.R., Crijns, Harry J.G.M., Oemrawsingh, Pranobe V., Gosselink, Marcel T.M., Plomp, Koos, Magro, Michael, Elbers, Paul W.G., van der Pas, Stéphanie, van Royen, Niels
• Format: Article
• Language: English
• Subjects: acute coronary syndrome; coronary angiography; out-of-hospital cardiac arrest
• ISSN: 2772-9303; 2772-9303
• DOI: 10.1016/j.jscai.2023.101191

In out-of-hospital cardiac arrest (OHCA) without ST-elevation, predictive markers that can identify those with a high risk of acute coronary syndrome are lacking. In this post hoc analysis of the Coronary Angiography after Cardiac Arrest (COACT) trial, the baseline, median, peak, and time-concentration curves of troponin-T (cTnT) (T-AUC) in OHCA patients without ST-elevation were studied. cTnT values were obtained at predefined time points at 0, 3, 6, 12, 24, 36, 28, and 72 hours after admission. All patients who died within the measurement period were not included. The primary outcome was the association between cTnT and 90-day survival. Secondary outcomes included the association of cTnT and acute thrombotic occlusions, acute unstable lesions, and left ventricular function. In total, 352 patients were included in the analysis. The mean age was 64 ± 13 years (80.4% men). All cTnT measures were independent prognostic factors for mortality after adjustment for potential confounders age, sex, history of coronary artery disease, witnessed arrest, time to BLS, and time to return of spontaneous circulation (eg, for T-AUC: hazard ratio, 1.44; 95% CI, 1.06-1.94; P = .02; P value for all variables ≤.02). Median cTnT (odds ratio [OR], 1.58; 95% CI, 1.18-2.12; P = .002) and T-AUC (OR, 2.03; 95% CI, 1.25-3.29; P = .004) were independent predictors for acute unstable lesions. Median cTnT (OR, 1.62; 95% CI, 1.17-2.23; P = .003) and T-AUC (OR, 2.16; 95% CI, 1.27-3.68; P = .004) were independent predictors for acute thrombotic occlusions. CTnT values were not associated with the left ventricular function (eg, for T-AUC: OR, 2.01; 95% CI, 0.65-6.19; P = .22; P value for all variables ≥.14) In OHCA patients without ST-segment elevation, cTnT release during the first 72 hours after return of spontaneous circulation was associated with clinical outcomes. [Display omitted] •Troponin-T release in the first days after return of spontaneous circulation was associated with survival.•Patients with significant coronary artery disease had higher troponin T values.•The performance of troponin T values in predicting survival was poor.•The performance in predicting acute coronary syndrome, troponin T had a fair discrimination ability.