Abstract P139: Prevalence of Troponin Elevations in Patients With Cardiac Arrest: Implications for Assessing Quality of Care in Hypothermia Centers
Background: The initial assessment of patients (pts) who have cardiac arrest (CA) includes serial cardiac biomarkers to detect acute myocardial infarction (MI). Newer generation Troponin (Tn) assays are more sensitive and can detect even minor amounts of myocardial damage. The ACC/ESC recommendations indicate that serial changes in Tn values that exceed the 99th percentile should be classified as MI. The prevalence of Tn elevations in CA pts has not been well described.
Methods: Adult, out-of-hospital, non-traumatic CA pts surviving to hospital admission were included. Pts were treated by protocol driven care that included routine use of hypothermia. Serial assessment of cardiac biomarkers, including Troponin I (TnI) were obtained over the initial 24–36 hours. Pts with STEMI (n=16) or who had only one TnI (n=1) result were excluded. TnI values were classified as: Detectable (0.03 to 0.99 ng/ml); MI, exceeding the 99th percentile and therefore meeting the ACC/ESC MI criteria (0.1–0.99 ng/ml); and sizeable elevation (TnI≥1.0 ng/ml). A TnI difference of >20% over the course of Tn sampling was considered significant.
Results: Over a 2 year period, 67 CA pts (mean age 58±16, 67% male) were included. Initial rhythm was VT/VF in 48%, PEA in 34%, and asystole in 18%. Overall survival was 42%. Detectable TnI was present in 85% of pts, with 46% meeting ACC/ESC MI criteria (Table⇓). Peak TnI exceeded the ACC/ESC criteria for MI in 66% of patients, with 91% having detectable TnI. A >20% change in TnI values was present in 90% of pts. Despite the frequency of TnI elevations, only 64% received a clinical diagnosis of non-STEMI on chart review.
Conclusions: All pts with CA who survived to admission had detectable TnI, most of whom met ACC/ESC criteria for MI. Given the high mortality of these pts, even with state of the art care, these data have important implications for quality of care metrics at hypothermia centers.