TY - JOUR
T1 - Coronary Angiography after Cardiac Arrest without ST-Segment Elevation
AU - Lemkes, Jorrit S.
AU - Janssens, Gladys N.
AU - van der Hoeven, Nina W.
AU - Jewbali, Lucia S. D.
AU - Dubois, Eric A.
AU - Meuwissen, Martijn
AU - Rijpstra, Tom A.
AU - Bosker, Hans A.
AU - Blans, Michiel J.
AU - Bleeker, Gabe B.
AU - Baak, Remon
AU - Vlachojannis, Georgios J.
AU - Eikemans, Bob J. W.
AU - van der Harst, Pim
AU - van der Horst, Iwan C. C.
AU - Voskuil, Michiel
AU - van der Heijden, Joris J.
AU - Beishuizen, Albertus
AU - Stoel, Martin
AU - Camaro, Cyril
AU - van der Hoeven, Hans
AU - Henriques, Jose P.
AU - Vlaar, Alexander P. J.
AU - Vink, Maarten A.
AU - van den Bogaard, Bas
AU - Heestermans, Ton A. C. M.
AU - de Ruijter, Wouter
AU - Delnoij, Thijs S. R.
AU - Crijns, Harry J. G. M.
AU - Jessurun, Gillian A. J.
AU - Oemrawsingh, Pranobe V.
AU - Gosselink, Marcel T. M.
AU - Plomp, Koos
AU - Magro, Michael
AU - Elbers, Paul W. G.
AU - van de Ven, Peter M.
AU - Oudemans-van Straaten, Heleen M.
AU - van Royen, Niels
N1 - Funding Information:
The trial was sponsored by the Netherlands Heart Institute, Biotronik, and AstraZeneca. The sponsors of the trial had no role in the design or monitoring of the trial; the selection of the participating centers; the enrollment of participants; the collection, recording, storage, retention, or analysis of the data; the writing of the manuscript; or the decision to submit the manuscript for publication.
Funding Information:
Supported by unrestricted research grants from the Netherlands Heart Institute, Biotronik, and AstraZeneca.
Funding Information:
Dr. Vlachojannis reports receiving grant support from Micro-Port Orthopedics and Daiichi Sankyo; and Dr. van Royen, receiving grant support from Philips, Biotronik, and Abbott and honoraria from Medtronic. No other potential conflict of interest relevant to this article was reported.
Publisher Copyright:
Copyright © 2019 Massachusetts Medical Society.
PY - 2019/4/11
Y1 - 2019/4/11
N2 - Background Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography and percutaneous coronary intervention (PCI) in the treatment of patients who have been successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains uncertain. Methods In this multicenter trial, we randomly assigned 552 patients who had cardiac arrest without signs of STEMI to undergo immediate coronary angiography or coronary angiography that was delayed until after neurologic recovery. All patients underwent PCI if indicated. The primary end point was survival at 90 days. Secondary end points included survival at 90 days with good cerebral performance or mild or moderate disability, myocardial injury, duration of catecholamine support, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, major bleeding, occurrence of acute kidney injury, need for renal-replacement therapy, time to target temperature, and neurologic status at discharge from the intensive care unit. Results At 90 days, 176 of 273 patients (64.5%) in the immediate angiography group and 178 of 265 patients (67.2%) in the delayed angiography group were alive (odds ratio, 0.89; 95% confidence interval [CI], 0.62 to 1.27; P=0.51). The median time to target temperature was 5.4 hours in the immediate angiography group and 4.7 hours in the delayed angiography group (ratio of geometric means, 1.19; 95% CI, 1.04 to 1.36). No significant differences between the groups were found in the remaining secondary end points. Conclusions Among patients who had been successfully resuscitated after out-of-hospital cardiac arrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days. (Funded by the Netherlands Heart Institute and others; COACT Netherlands Trial Register number, .)Patients who had cardiac arrest without ST-segment elevation were assigned to undergo either immediate coronary angiography or delayed coronary angiography (after neurologic recovery). All patients underwent PCI if indicated. There was no significant between-group difference in overall survival at 90 days.
AB - Background Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography and percutaneous coronary intervention (PCI) in the treatment of patients who have been successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains uncertain. Methods In this multicenter trial, we randomly assigned 552 patients who had cardiac arrest without signs of STEMI to undergo immediate coronary angiography or coronary angiography that was delayed until after neurologic recovery. All patients underwent PCI if indicated. The primary end point was survival at 90 days. Secondary end points included survival at 90 days with good cerebral performance or mild or moderate disability, myocardial injury, duration of catecholamine support, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, major bleeding, occurrence of acute kidney injury, need for renal-replacement therapy, time to target temperature, and neurologic status at discharge from the intensive care unit. Results At 90 days, 176 of 273 patients (64.5%) in the immediate angiography group and 178 of 265 patients (67.2%) in the delayed angiography group were alive (odds ratio, 0.89; 95% confidence interval [CI], 0.62 to 1.27; P=0.51). The median time to target temperature was 5.4 hours in the immediate angiography group and 4.7 hours in the delayed angiography group (ratio of geometric means, 1.19; 95% CI, 1.04 to 1.36). No significant differences between the groups were found in the remaining secondary end points. Conclusions Among patients who had been successfully resuscitated after out-of-hospital cardiac arrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days. (Funded by the Netherlands Heart Institute and others; COACT Netherlands Trial Register number, .)Patients who had cardiac arrest without ST-segment elevation were assigned to undergo either immediate coronary angiography or delayed coronary angiography (after neurologic recovery). All patients underwent PCI if indicated. There was no significant between-group difference in overall survival at 90 days.
KW - ACUTE MYOCARDIAL-INFARCTION
KW - VENTRICULAR-FIBRILLATION
KW - EUROPEAN-SOCIETY
KW - TASK-FORCE
KW - INTERVENTION
KW - IMMEDIATE
KW - RESUSCITATION
KW - ASSOCIATION
KW - MANAGEMENT
KW - SURVIVORS
U2 - 10.1056/NEJMoa1816897
DO - 10.1056/NEJMoa1816897
M3 - Article
C2 - 30883057
SN - 0028-4793
VL - 380
SP - 1397
EP - 1407
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 15
ER -