Purpose: 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. Methods: 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. Results: During the 5 years study period, 272 patients (median age 60y, 76.5% men) were included, and a culprit coronary occlusion was found in 133 (48.9%). Median HsTnT at admission was 551 (IQR 203-2551) ng/l, up to three times higher in patients with compared to those without a recent coronary occlusion (1184 vs. 351 ng/l; p<0.0001). 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 minutes (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 ≥ 575ng/l (OR 2.22, 95% CI 1.16-4.27) were associated with the presence of a recent coronary occlusion. The AUROC curves of the multivariate model identified above were not statistically better than those of the same model with established risk factors but without HsTnT (AUROC curves= 0.78 vs. 0.79; p=0.23). Nevertheless, adding HsTnT to established risk factors of recent coronary occlusion identified above provided a non-significant NRI of -0.43%. Reclassification was not better in the subgroup of patients without ST-segment elevation (NRI= 0.105±0.078, p=0.18). Conclusions: 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.
1040 Sudden Cardiac Death and ICD diac condition in 43% of families.The systematic use of AjPt with high RPLs increases substantially the yield of BrS.
met.2013.0393 Auteur(s) : Florence Dumas florence.dumas@cch.aph.fr, Guillaume Geri, Alain Cariou Hopital Broca Cochin, Hotel-Dieu, service d’accueil des urgences, service de reanimation medicale, universite Paris Descartes, Inserm U970, equipe 4 (Paris Cardiovascular Research Center), 27, rue du Faubourg-Saint, 75679 Paris cedex 14, France Tires a part : F. Dumas Malgre les efforts accomplis au cours des deux dernieres decennies, le pronostic des sujets presentant un arret cardiaque (AC) [...]
Background: The proportion of out-of-hospital cardiac arrest due to non-shockable rhythms or non-cardiac etiology is increasing. Little is known about long-term prognosis following resuscitation, especially as it relates to the presenting rhythm or arrest etiology. We investigated long-term survival among those discharged alive following resuscitation overall and according to presenting rhythm and etiology. Methods: We conducted a cohort investigation of all adults suffering out-of-hospital cardiac arrest in a large metropolitan EMS system between Jan 1,2001 and Dec 31,2009 who were resuscitated and discharged from hospital. We prospectively collected pre-hospital data including initial rhythm and arrest etiology. Long-term vital status was ascertained using death certificate records through Dec 31,2010. We used Kaplan Meier and Cox regression to evaluate survival. Results: During the study period, 6149 adults received EMS resuscitation,of whom 4165 (69%) presented a non-shockable rhythm and 2198 (36%) had a non-cardiac etiology. A total of 1001 were discharged alive, of whom 316/1001 (32%) presented a non-shockable rhythm and 213/1001 (21%) had a non-cardiac etiology. Overall median survival was 9.8 yrs with 62% surviving >5-yrs after hospital discharge. Five-year survival was 42% for non-shockable rhythms compared to 71% for shockable rhythms,and 45% for non-cardiac etiology compared to 66% for cardiac etiology (p<0.01 respectively) (Fig1). Conclusion: Cardiac arrest due to non-shockable rhythm or non-cardiac etiology comprises a substantial proportion of those who survive and are discharged from the hospital. Although long-term survival in these groups is less than their shockable or cardiac etiology counterparts, over half are alive 4 years following hospital discharge, a finding that suggests meaningful survival and supports continued efforts to improve resuscitation care for those with non-shockable rhythms or non-cardiac cause.
The availability of circulating biomarkers that helps to identify early out-of-hospital cardiac arrest survivors who are at increased risk of long-term mortality remains challenging. Our aim was to prospectively study the association between copeptin and 1-year mortality in patients with out-of-hospital cardiac arrest admitted in a tertiary cardiac arrest center.Retrospective monocenter study.Tertiary cardiac arrest center in Paris, France.Copeptin was assessed at admission and day 3. Pre- and intrahospital factors associated with 1-year mortality were analyzed by multivariate Cox proportional analysis.None.Two hundred ninety-eight consecutive out-of-hospital cardiac arrest patients (70.3% male; median age, 60.2 yr [49.9-71.4]) were admitted in a tertiary cardiac arrest center in Paris (France). After multivariate analysis, higher admission copeptin was associated with 1-year mortality with a threshold effect (hazard ratio(5th vs 1st quintile) = 1.64; 95% CI, 1.05-2.58; p = 0.03). Day 3 copeptin was associated with 1-year mortality in a dose-dependent manner (hazard ratio(2nd vs 1st quintile) = 1.87; 95% CI, 1.00-3.49; p = 0.05; hazard ratio(3rd vs 1st quintile) = 1.92; 95% CI, 1.02-3.64; p = 0.04; hazard ratio(4th vs 1st quintile) = 2.12; 95% CI, 1.14-3.93; p = 0.02; and hazard ratio(5th vs 1st quintile) = 2.75; 95% CI, 1.47-5.15; p < 0.01; p for trend < 0.01). For both admission and day 3 copeptin, association with 1-year mortality existed for out-of-hospital cardiac arrest of cardiac origin only (p for interaction = 0.05 and < 0.01, respectively). When admission and day 3 copeptin were mutually adjusted, only day 3 copeptin remained associated with 1-year mortality in a dose-dependent manner (p for trend = 0.01).High levels of copeptin were associated with 1-year mortality independently from prehospital and intrahospital risk factors, especially in out-of-hospital cardiac arrest of cardiac origin. Day 3 copeptin was superior to admission copeptin: this could permit identification of out-of-hospital cardiac arrest survivors at increased risk of mortality and allow for close observation of such patients.
Background: Sports-related sudden cardiac arrest (sport SCA) has always attracted attention and the United States and European Union have developed divergent strategies for prevention over the last decade; notably regarding screening of younger athletes but also for SCA prevention in middle-aged and senior individuals. In this context, the extent to which outcomes of sports SCA differ between Europe and the USA have not been characterized. Methods: SCA cases aged 15-75 years were identified in two large prospective, population-based SCA programs, one in the Paris region (Paris-SDEC) and the other in a Northwestern US metro region (Oregon-SUDS) between 2002 and 2012. Cases of SCA, occurring during sports activity were compared between the two regions. Results: Of the 7,357 cases studied, 290 (4%) occurred during sports, with very similar proportions in both regions: 86 out of 1,894 (4.5%) in Oregon and 204 out of 5,463 (3.8%) in Paris. Subjects’ characteristics of cases in both programs were very similar (Paris vs. Oregon, respectively, for all results following), regarding age (50.7±14 vs. 50.4±13 years, P=0.55), male proportion (94%vs. 92%, P=0.53), past medical history of ≥2 cardiovascular risk factors (16% vs. 23%, P=0.16) and/or heart disease (10% vs. 8%, P=0.55). There was a high proportion of witnessed events in both populations (89% vs. 90%, P=0.94). However, we observed significant differences with more bystander cardiopulmonary resuscitation in Paris (63% vs. 48%, P=0.02), faster response time in Oregon (8.3±6 vs. 6.9±4 min, P=0.05), and more initially shockable rhythms in Oregon (52% vs. 70%, P=0.006). Overall, resuscitation outcomes were very similar for return of spontaneous circulation (26% vs. 33%, P=0.21) and survival to hospital discharge (27% vs. 26%, P=0.80). Conclusions: On either side of the Atlantic, burden and characteristics of sports-related SCA are very similar. Survival rates are approximately one in four cases. Optimizing bystander cardiopulmonary resuscitation rates and emergency response times could further improve outcomes. Deployment of uniform, effective strategies for screening and prevention are likely to make the greatest impact on sports SCA.
