Steffen Desch, MD from the Heart Center Leipzig at the University of Leipzig - Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation.
Link to Abstract:
Out-of-hospital cardiac arrest is frequently caused by myocardial infarction. The advantages of Heart Center Leipzig at the University of Leipzig f early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST-segment elevation, on the other hand, remain unknown.
PRIMARY RESEARCH METHODS -
554 patients with successfully resuscitated out-of-hospital cardiac arrest of suspected coronary origin were randomly allocated to either immediate coronary angiography (immediate-angiography group) or initial intensive care evaluation with delayed or selective angiography in this multicenter study (delayed-angiography group). On post-resuscitation electrocardiography, none of the patients showed ST-segment elevation. At 30 days, the primary end objective was death from any cause. At 30 days, a composite of death from any cause or significant neurologic impairment was used as a secondary end objective.
In the primary analysis, 530 out of 554 patients (95.7 percent) were included. At 30 days, 143 of 265 patients in the immediate-angiography group (54.0%) and 122 of 265 patients (46.0%) in the delayed-angiography group (hazard ratio, 1.28; 95 percent confidence interval [CI], 1.00 to 1.63; P=0.06) had died (hazard ratio, 1.28; 95 percent confidence interval [CI], 1.00 to 1.63; P=0.06). The immediate-angiography group had a higher relative risk of mortality or severe neurologic impairment (164 of 255 patients [64.3 percent ]) than the delayed-angiography group (138 of 248 patients [55.6 percent ]), with a relative risk of 1.16. (95 percent CI, 1.00 to 1.34). The two groups had identical values for peak troponin release, as well as the incidence of moderate or severe bleeding, stroke, and renal replacement therapy.
FINAL THOUGHTS -
Immediate angiography had no benefit over a delayed or selective approach in patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation in terms of the 30-day risk of mortality from any cause. (ToMAHAWK ClinicalTrials.gov number: NCT02750462. opens in a new tab; funded by the German Center for Cardiovascular Research.)