COACT: One-Year Outcomes of Coronary Angiography after Cardiac Arrest without ST Segment Elevation

In patients with return of spontaneous circulation (ROSC) after following out-of-hospital cardiac arrest (OHCA) without signs of ST-elevation myocardial infarction (STEMI), immediate coronary angiography was not found to improve survival at one year when compared to delayed coronary angiography, according to a new study presented at the American Heart Association Scientific Sessions 2019 in Philadelphia.

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in Europe and the United States. Despite advances in the field of resuscitation and intensive care management, the outcome of these patients remains poor. The most frequent cause of cardiac arrest is ischemic heart disease. In patients with myocardial infarction as cause of the arrest, immediate coronary angiography (CAG) and subsequent percutaneous coronary intervention (PCI) potentially improves outcome.

Researchers of this this randomized, open-label multicenter trial sought to discern the effect of an immediate versus delayed invasive approach on survival and the occurrence of major cardiac events (MACE) at one year. They randomized 552 OHCA patients without ST segment elevation on the electrocardiogram (ECG) to undergo either an immediate or delayed invasive strategy in a 1:1 fashion. For the purpose of this study, MACE was stipulated as death, myocardial infarction, coronary bypass grafting and percutaneous coronary intervention with hospitalizations for heart failure also reported.

According to the results of the study, after one year, 61.4% of patients in the immediate angiography group and 64.0% of patients were alive, respectively (OR=0.90; 95% CI, 0.63 to 1.28). The researchers observed no differences between the groups with respect to the other end points at after follow-up. As such, they concluded that strategy of immediate angiography was not found to be superior compared to a strategy of delayed angiography in patients after cardiac arrest with respect to clinical outcomes after year.

“There was no significant difference in the rates of myocardial infarction, revascularization, hospitalization due to heart failure or ICD shocks between the two treatment groups at one year,” the presentation noted.