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Immediate coronary angiography after cardiac arrest does not improve survival

Presented by
Dr Jorrit Lemkes, Amsterdam University Medical Center, the Netherlands
AHA 2019
Immediate coronary angiography after cardiac arrest did not improve survival at 1 year compared with delaying the procedure in resuscitated patients who had had out-of-hospital cardiac arrest (OHCA) without ST segment elevation (STE).

Dr Jorrit Lemkes (Amsterdam University Medical Center, the Netherlands) presented the 1-year follow-up data from the Coronary Angiography after Cardiac Arrest (COACT) trial [1], which was the first randomised trial in cardiac arrest patients without STE investigating whether immediate angiography could improve survival and major adverse cardiac events at 1 year, as opposed to a delayed invasive strategy. This open-label, multicentre trial enrolled 552 OHCA patients who were allocated to receive either immediate angiography (n=264) or delayed angiography (n=258).

Survival at 90 days was the primary endpoint. Secondary endpoints included survival at 90 days with good cerebral performance or moderate disability, thrombolysis in myocardial infarction major bleeding, recurrence of ventricular tachycardia, occurrence of acute kidney injury and need for renal-replacement therapy, time-to-target temperature, duration of inotropic/catecholamine support, duration of mechanical ventilation, myocardial injury, and markers of shock.

The results did not indicate significant improvement with immediate angiography; 1-year survival outcomes were 61.4% of patients in the immediate angiography group and 64.0% of patients in the delayed group (OR 0.90; 95% CI 0.63-1.28). Additionally, no significant differences were observed in the rates of myocardial infarction, revascularisation, hospitalisation due to heart failure, or implantable cardioverter defibrillator (ICD) shocks between the 2 treatment groups at 1 year. These results do not support a strategy of immediate angiography with intent to revascularise for patients with resuscitated OHCA without STE.

1. Lemkes J, et al. One Year Outcomes of Coronary Angiography After Cardiac Arrest. LBS04, AHA Scientific Sessions 2019, 14-18 November, Philadelphia, USA.

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