TY - JOUR
T1 - Coronary Angiography After Cardiac Arrest Without ST Segment Elevation
T2 - One-Year Outcomes of the COACT Randomized Clinical Trial
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 M.
AU - Rijpstra, Topm A.
AU - Bosker, Hans A.
AU - Blans, Michiel J.
AU - Bleeker, Gabe B.
AU - Baak, Remon R.
AU - Vlachojannis, George 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 - Spoormans, Eva M.
AU - van de Ven, Peter M.
AU - Oudemans-van Straaten, Heleen M.
AU - van Royen, Niels
PY - 2020/12
Y1 - 2020/12
N2 - ImportanceIschemic heart disease is a common cause of cardiac arrest. However, randomized data on long-term clinical outcomes of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients successfully resuscitated from cardiac arrest in the absence of ST segment elevation myocardial infarction (STEMI) are lacking. ObjectiveTo determine whether immediate coronary angiography improves clinical outcomes at 1 year in patients after cardiac arrest without signs of STEMI, compared with a delayed coronary angiography strategy. Design, Setting, and ParticipantsA prespecified analysis of a multicenter, open-label, randomized clinical trial evaluated 552 patients who were enrolled in 19 Dutch centers between January 8, 2015, and July 17, 2018. The study included patients who experienced out-of-hospital cardiac arrest with a shockable rhythm who were successfully resuscitated without signs of STEMI. Follow-up was performed at 1 year. Data were analyzed, using the intention-to-treat principle, between August 29 and October 10, 2019. InterventionsImmediate coronary angiography and PCI if indicated or coronary angiography and PCI if indicated, delayed until after neurologic recovery. Main Outcomes and MeasuresSurvival, myocardial infarction, revascularization, implantable cardiac defibrillator shock, quality of life, hospitalization for heart failure, and the composite of death or myocardial infarction or revascularization after 1 year. ResultsAt 1 year, data on 522 of 552 patients (94.6%) were available for analysis. Of these patients, 413 were men (79.1%); mean (SD) age was 65.4 (12.3) years. A total of 162 of 264 patients (61.4%) in the immediate angiography group and 165 of 258 patients (64.0%) in the delayed angiography group were alive (odds ratio, 0.90; 95% CI, 0.63-1.28). The composite end point of death, myocardial infarction, or repeated revascularization since the index hospitalization was met in 112 patients (42.9%) in the immediate group and 104 patients (40.6%) in the delayed group (odds ratio, 1.10; 95% CI, 0.77-1.56). No significant differences between the groups were observed for the other outcomes at 1-year follow-up. For example, the rate of ICD shocks was 20.4% in the immediate group and 16.2% in the delayed group (odds ratio, 1.32; 95% CI, 0.66-2.64). Conclusions and RelevanceIn this trial of patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, a strategy of immediate angiography was not found to be superior to a strategy of delayed angiography with respect to clinical outcomes at 1 year. Coronary angiography in this patient group can therefore be delayed until after neurologic recovery without affecting outcomes.
AB - ImportanceIschemic heart disease is a common cause of cardiac arrest. However, randomized data on long-term clinical outcomes of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients successfully resuscitated from cardiac arrest in the absence of ST segment elevation myocardial infarction (STEMI) are lacking. ObjectiveTo determine whether immediate coronary angiography improves clinical outcomes at 1 year in patients after cardiac arrest without signs of STEMI, compared with a delayed coronary angiography strategy. Design, Setting, and ParticipantsA prespecified analysis of a multicenter, open-label, randomized clinical trial evaluated 552 patients who were enrolled in 19 Dutch centers between January 8, 2015, and July 17, 2018. The study included patients who experienced out-of-hospital cardiac arrest with a shockable rhythm who were successfully resuscitated without signs of STEMI. Follow-up was performed at 1 year. Data were analyzed, using the intention-to-treat principle, between August 29 and October 10, 2019. InterventionsImmediate coronary angiography and PCI if indicated or coronary angiography and PCI if indicated, delayed until after neurologic recovery. Main Outcomes and MeasuresSurvival, myocardial infarction, revascularization, implantable cardiac defibrillator shock, quality of life, hospitalization for heart failure, and the composite of death or myocardial infarction or revascularization after 1 year. ResultsAt 1 year, data on 522 of 552 patients (94.6%) were available for analysis. Of these patients, 413 were men (79.1%); mean (SD) age was 65.4 (12.3) years. A total of 162 of 264 patients (61.4%) in the immediate angiography group and 165 of 258 patients (64.0%) in the delayed angiography group were alive (odds ratio, 0.90; 95% CI, 0.63-1.28). The composite end point of death, myocardial infarction, or repeated revascularization since the index hospitalization was met in 112 patients (42.9%) in the immediate group and 104 patients (40.6%) in the delayed group (odds ratio, 1.10; 95% CI, 0.77-1.56). No significant differences between the groups were observed for the other outcomes at 1-year follow-up. For example, the rate of ICD shocks was 20.4% in the immediate group and 16.2% in the delayed group (odds ratio, 1.32; 95% CI, 0.66-2.64). Conclusions and RelevanceIn this trial of patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, a strategy of immediate angiography was not found to be superior to a strategy of delayed angiography with respect to clinical outcomes at 1 year. Coronary angiography in this patient group can therefore be delayed until after neurologic recovery without affecting outcomes.
KW - MYOCARDIAL-INFARCTION
KW - INTERVENTION
KW - IMMEDIATE
KW - SECONDARY
U2 - 10.1001/jamacardio.2020.3670
DO - 10.1001/jamacardio.2020.3670
M3 - Article
C2 - 32876654
SN - 2380-6583
VL - 5
SP - 1358
EP - 1365
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 12
ER -