A strategy of immediate coronary angiography and percutaneous coronary intervention (PCI) does not improve outcomes following successful resuscitation after out-of-hospital cardiac arrest (OHCA) in the absence of ST-segment elevation myocardial infarction (STEMI). This finding from the COACT study was presented at ACC.19.
Recommended care after successful cardiac resuscitation includes targeted temperature management, vital-organ support and treatment of the underlying cause of the cardiac arrest; however, the underlying cause is not always immediately known, leading to uncertainty about the appropriate treatment strategy. The COACT investigators hypothesized that immediate angiography might reduce the time delay to PCI in indicated patients and thereby improve myocardial salvage.
In this multicentre trial, 552 patients with cardiac arrest but no signs of STEMI were randomly assigned to undergo immediate coronary angiography or coronary angiography that was delayed until after neurological recovery. All patients underwent PCI if indicated.
After 90 days of follow-up, survival was 64.5% in the immediate-angiography group compared with 67.2% in the delayed-angiography group (OR 0.89, 95% CI 0.62–1.27, P = 0.51). Of note, the median time to achieving target temperature was 5.4 h and 4.7 h in each group, respectively. “A later achievement of target temperature might have attenuated any potential benefit gained from immediate coronary angiography,” speculate the investigators. Another factor influencing the results might be the proportion of patients with stable coronary artery lesions versus thrombotic occlusions (only 5% in the COACT trial).
Lemkes, J. S. et al. Coronary angiography after cardiac arrest without ST-segment elevation. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa1816897 (2019)
Berg, D. D. et al. Key components of a community response to out-of-hospital cardiac arrest. Nat. Rev. Cardiol. https://doi.org/10.1038/s41569-019-0175-4 (2019)
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Lim, G.B. Immediate angiography does not improve outcomes after OHCA without STEMI. Nat Rev Cardiol 16, 322 (2019). https://doi.org/10.1038/s41569-019-0196-z