Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Universitaire Cochin Broca Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15 rue de l'Ecole de Médecine, 75006 Paris, France.
Int J Cardiol. 2013 Nov 30;169(6):449-54. doi: 10.1016/j.ijcard.2013.10.011. Epub 2013 Oct 16.
Early identification of the cause of out-of-hospital cardiac arrest (OHCA) remains a challenge. Our aim was to determine whether high-sensitivity cardiac troponin T (HsTnT) was useful to diagnose a recent coronary artery occlusion as the cause of OHCA.
Retrospective study including OHCA patients evaluated by systematic coronary angiogram at hospital admission. HsTnT was assessed at ICU admission. Predictive factors of a recent coronary occlusion were identified by logistic regression. Net reclassification improvement (NRI) was calculated to estimate the potential enhancement of prediction with HsTnT.
During the 5 year study period, 272 patients (median age 60 y, 76.5% men) were included, and a culprit coronary occlusion was found in 133 (48.9%). The optimum HsTnT cut-off to predict a recent coronary occlusion was 575 ng/l (sensitivity 65.4%, specificity 65.5%). In multivariate analysis, current smoking (OR 3.2 95%, 95%CI 1.62-6.33), time from collapse to BLS<3 min (OR 2.11, 95%CI 1.10-4.05), initial shockable rhythm (OR 5.29, 95%CI 2.06-13.62), ST-segment elevation (OR 2.44, 95%CI 1.18-5.03), post-resuscitation shock onset (OR 2.03, 95%CI 1.01-4.07) and HsTnT≥575 ng/l (OR 2.22, 95%CI 1.16-4.27) were associated with the presence of a recent coronary occlusion. Nevertheless, adding HsTnT to established risk factors of recent coronary occlusion identified above provided a non-significant NRI of -0.43%.
Admission HsTnT is increased after OHCA and is an independent factor of a recent coronary occlusion. However, HsTnT does not seem to be a strong enough diagnostic tool to select candidates for emergent coronary angiogram in OHCA survivors.
院外心脏骤停（OHCA）的病因早期识别仍然是一个挑战。我们的目的是确定高敏心肌肌钙蛋白 T（HsTnT）是否有助于诊断 OHCA 患者近期冠状动脉闭塞的病因。
这是一项回顾性研究，纳入了入院时接受系统冠状动脉造影评估的 OHCA 患者。在 ICU 入院时评估 HsTnT。通过逻辑回归确定近期冠状动脉闭塞的预测因素。计算净重新分类改善（NRI）以估计 HsTnT 对预测的潜在增强作用。
在 5 年的研究期间，共纳入 272 例患者（中位年龄 60 岁，76.5%为男性），其中 133 例（48.9%）存在罪犯性冠状动脉闭塞。预测近期冠状动脉闭塞的最佳 HsTnT 截断值为 575ng/L（敏感性 65.4%，特异性 65.5%）。多变量分析显示，当前吸烟（OR 3.2，95%CI 1.62-6.33）、从心脏骤停到基础生命支持<3 分钟（OR 2.11，95%CI 1.10-4.05）、初始可除颤节律（OR 5.29，95%CI 2.06-13.62）、ST 段抬高（OR 2.44，95%CI 1.18-5.03）、复苏后休克发生（OR 2.03，95%CI 1.01-4.07）和 HsTnT≥575ng/L（OR 2.22，95%CI 1.16-4.27）与近期冠状动脉闭塞有关。然而，将 HsTnT 加入上述确定的近期冠状动脉闭塞的既定危险因素中，并未提供显著的 NRI（-0.43%）。
OHCA 后 HsTnT 升高，是近期冠状动脉闭塞的独立因素。然而，对于 OHCA 幸存者，HsTnT 似乎不是一种足够强的诊断工具，无法选择进行紧急冠状动脉造影的候选者。
