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Diagnostic Value of High-Sensitivity Cardiac Troponin-I in Patients After Out-of-Hospital Cardiac Arrest

Boaz Elad1, Doron Aronson2, Doron Cohn-Schwartz3

  • 1Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.

The American Journal of Cardiology
|September 27, 2023
PubMed

Insights

High-sensitivity cardiac troponin-I (hs-cTnI) levels, specifically peak levels and upslope, can help diagnose acute myocardial infarction (AMI) in out-of-hospital cardiac arrest (OHCA) survivors. These markers show good discrimination between AMI and non-AMI causes of OHCA.

Area of Science:

  • Cardiology
  • Biomarkers
  • Emergency Medicine

Background:

  • Determining the cause of cardiac arrest (CA) is crucial for effective treatment. Previous studies on cardiac troponin's diagnostic role in CA survivors yielded controversial results.
  • Few studies have investigated high-sensitivity cardiac troponin-I (hs-cTnI) during the current era, and its kinetic patterns post-CA remain underexplored.

Purpose of the Study:

  • To evaluate the diagnostic utility of hs-cTnI in patients who have been resuscitated from out-of-hospital cardiac arrest (OHCA).
  • To compare hs-cTnI levels and kinetics between patients with and without acute myocardial infarction (AMI) as the cause of OHCA.

Main Methods:

  • A retrospective analysis of 201 consecutive OHCA patients admitted to a cardiac intensive care unit between 2016 and 2021.
  • Patients were categorized into two groups: those with confirmed AMI and those without AMI as the cause of CA.
  • hs-cTnI levels at admission, peak levels, and the upslope of hs-cTnI were compared between the groups.

Main Results:

  • Significant differences were observed in peak hs-cTnI levels (median 1,424 vs 32,558 ng/L) and hs-cTnI upslope (median 109 vs 2,322 ng/L/h) between non-AMI and AMI groups (p < 0.0001 for both).
  • Peak hs-cTnI and hs-cTnI upslope demonstrated good discriminatory performance, with areas under the receiver operating characteristic curves of 0.83 and 0.80, respectively.

Conclusions:

  • Peak hs-cTnI levels and hs-cTnI upslope are valuable adjuncts for diagnosing the etiology of CA in OHCA survivors.
  • These hs-cTnI metrics can aid in differentiating between AMI and non-AMI causes of cardiac arrest, supporting clinical decision-making.

Keywords:
hs-cardiac TnIout-of-hospital cardiac arrest

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