Implication of cardiac marker elevation in patients who resuscitated from out-of-hospital cardiac arrest

• Published in: The American journal of emergency medicine Vol. 30; no. 3; pp. 464 - 471
• Main Authors: Hoon Oh, Sang, MD, Min Kim, Young, MD, PhD, Joon Kim, Han, MD, PhD, Song Youn, Chun, MD, Pill Choi, Seung, MD, PhD, Hee Wee, Jung, MD, Hyun Kim, Soo, MD, Jung Jeong, Won, MD, Nam Park, Kyu, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2012; Elsevier; Elsevier Limited
• Subjects: Acute coronary syndromes; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - blood; Blood clots; Cardiac arrest; Cardiopulmonary Resuscitation; Cardiovascular disease; Case-Control Studies; Coronary vessels; Creatine Kinase, MB Form - blood; Electrocardiography; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency medical care; Female; Heart attacks; Humans; Intensive care medicine; Ischemia; Male; Medical imaging; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Out-of-Hospital Cardiac Arrest - blood; Out-of-Hospital Cardiac Arrest - etiology; Out-of-Hospital Cardiac Arrest - therapy; Retrospective Studies; Troponin I - blood; Out of hospital; Cardiovascular disease; Cardiocirculatory arrest; Intensive care; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2010.12.022

Abstract Objectives It is often difficult to diagnose acute myocardial infarction (AMI) in patients who resuscitated after out-of-hospital cardiac arrest (OHCA) and had a delayed elevation in cardiac marker. This study explored whether elevations in cardiac marker were due to coronary artery occlusion or resulted from other causes. Methods The study included 19 non–ST-segment elevation patients who resuscitated after OHCA and underwent delayed coronary angiography. We checked patients' serial creatine kinase–myocardial band (CK-MB) and troponin I (cTnI) levels on arrival and 6, 12, 24, 48, 72, and 96 hours postarrest. Based on the association of elevated cTnI and the results of their delayed angiographies, the patients were retrospectively divided into 2 groups: an AMI group (n = 5) and a non-AMI group (n = 14). We then analyzed the serial cardiac marker measurements in each group. Results Peak marker levels were significantly higher in the AMI group than in the non-AMI group (CK-MB, 177.0 ± 112.7 vs 66.4 ± 85.2 ng/mL; P = .033 and cTnI, 40.4 ± 14.5 vs 10.6 ± 13.5 ng/mL; P = .005). After adjusting for covariates, the peak and 6-, 12-, and 24-hour cTnI and 6-hour CK-MB were significantly different between the 2 groups ( P = .005, P = .004, P = .005, P = .020, and P = .007). In the non-AMI group, 3 patients had cTnI values that were within the reference range at all of the evaluated times. Most patients had only low cTnI elevations that rapidly fell back to normal. Conclusion The resuscitation of patients who experience sudden OHCA but do not have an AMI may lead to elevations of cardiac markers. However, these elevations are low and normalize early.