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Coronary angiography after cardiac arrest: Rationale and design of the COACT trial
Jorrit S Lemkes1, Gladys N Janssens1, Heleen M Oudemans-van Straaten2
1Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands.
Insights
Immediate coronary angiography and intervention after cardiac arrest without STEMI may improve survival. This study investigates if early invasive procedures enhance 90-day survival in these critical patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Interventional Cardiology
Background:
- Ischemic heart disease frequently leads to out-of-hospital cardiac arrest.
- The benefit of immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI) in cardiac arrest survivors without ST-segment elevation myocardial infarction (STEMI) is uncertain.
Purpose of the Study:
- To test the hypothesis that immediate CAG and PCI improve 90-day survival in post-cardiac arrest patients without STEMI.
- To evaluate the impact of an early invasive coronary strategy on key clinical outcomes.
Main Methods:
- A prospective, multicenter, randomized controlled trial involving 552 patients.
- Patients without STEMI after restoration of spontaneous circulation were randomized to immediate CAG/PCI (within 2 hours) or delayed procedures.
- The primary endpoint was 90-day survival, with secondary endpoints including neurological status and organ injury.
Main Results:
- The study is designed to evaluate the effect of immediate CAG and PCI.
- Results regarding the primary endpoint of 90-day survival are pending.
Conclusions:
- The COACT trial will determine the efficacy of an immediate invasive coronary strategy in post-cardiac arrest patients without STEMI.
- Findings will guide clinical practice regarding the timing of cardiac interventions in this patient population.
Background:
Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI) after restoration of spontaneous circulation following cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains debated.
Hypothesis:
We hypothesize that immediate CAG and PCI, if indicated, will improve 90-day survival in post-cardiac arrest patients without signs of STEMI.
Design:
In a prospective, multicenter, randomized controlled clinical trial, 552 post-cardiac arrest patients with restoration of spontaneous circulation and without signs of STEMI will be randomized in a 1:1 fashion to immediate CAG and PCI (within 2 hours) versus initial deferral with CAG and PCI after neurological recovery. The primary end point of the study is 90-day survival. The secondary end points will include 90-day survival with good cerebral performance or minor/moderate disability, myocardial injury, duration of inotropic support, occurrence of acute kidney injury, need for renal replacement therapy, time to targeted temperature control, neurological status at intensive care unit discharge, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, and reasons for discontinuation of treatment.
Summary:
The COACT trial is a multicenter, randomized, controlled clinical study that will evaluate the effect of an immediate invasive coronary strategy in post-cardiac arrest patients without STEMI on 90-day survival.
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