High-sensitivity troponin T for detection of culprit lesions in patients with out-of-hospital cardiac arrest

Area of Science:

• Cardiology
• Emergency Medicine
• Biomarkers

Background:

• Out-of-hospital cardiac arrest (OHCA) patients often undergo coronary angiography, yet culprit lesions are identified in only 30-40% of cases.
• Investigating high-sensitivity troponin T (hsTnT) levels in OHCA patients is crucial for understanding their correlation with coronary culprit lesions.

Purpose of the Study:

• To examine hsTnT levels in OHCA patients with and without coronary culprit lesions.
• To identify factors influencing hsTnT levels post-return of spontaneous circulation (ROSC).
• To evaluate the diagnostic accuracy of hsTnT in detecting coronary culprit lesions.

Main Methods:

• Retrospective observational study of Intensive Care Unit patients following OHCA who underwent coronary angiography.
• Analysis of peak hsTnT values and dynamic changes in relation to identified culprit lesions.

Main Results:

• Patients with culprit lesions exhibited higher hsTnT levels within 48 hours post-OHCA, correlating with longer time to ROSC and unwitnessed arrests.
• A hsTnT cutoff of 1690 ng/L between 6-12 hours post-ROSC showed 64% sensitivity and 84% specificity for culprit lesions.
• In non-ST-elevation patients, hsTnT between 6-12 hours post-ROSC had >90% specificity but only 46% sensitivity.

Conclusions:

• Elevated hsTnT levels post-cardiac arrest are associated with coronary culprit lesions.
• Culprit lesion presence, witnessed status, and CPR duration impact hsTnT levels.
• Repeated hsTnT measurements improve accuracy, but early hsTnT has limited predictive value for culprit lesions in OHCA.