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Coronary Angiography after Cardiac Arrest without ST-Segment Elevation.

Jorrit S Lemkes1, Gladys N Janssens1, Nina W van der Hoeven1

  • 1From the Departments of Cardiology (J.S.L., G.N.J., N.W.H., N.R.), Intensive Care Medicine (P.W.G.E., H.M.O.-S.), and Epidemiology and Biostatistics (P.M.V.), Amsterdam University Medical Center VUmc, the Departments of Cardiology (J.P.H.) and Intensive Care Medicine (A.P.J.V.), Amsterdam University Medical Center AMC, and the Departments of Cardiology (M.A.V.) and Intensive Care Medicine (B.B.), Onze Lieve Vrouwe Gasthuis, Amsterdam, the Thorax Center, Erasmus Medical Center (L.S.D.J., E.A.D.), and the Departments of Cardiology (G.J.V.) and Intensive Care Medicine (B.J.W.E.), Maasstad Hospital, Rotterdam, the Departments of Cardiology (M. Meuwissen) and Intensive Care Medicine (T.A.R.), Amphia Hospital, Breda, the Departments of Cardiology (H.A.B.) and Intensive Care Medicine (M.J.B.), Rijnstate Hospital, Arnhem, the Departments of Cardiology (G.B.B.) and Intensive Care Medicine (R.B.), Haga Hospital, and the Department of Cardiology, Haaglanden Medical Center (P.V.O.), The Hague, the Departments of Cardiology (P.H.) and Intensive Care Medicine (I.C.C.H.), University of Groningen, Groningen, the Departments of Cardiology (M.V.) and Intensive Care Medicine (J.J.H.), University Medical Center Utrecht, Utrecht, the Departments of Intensive Care Medicine (A.B.) and Cardiology (M.S.), Medisch Spectrum Twente, Enschede, the Departments of Cardiology (C.C., N.R.) and Intensive Care Medicine (H.H.), Radboud University Medical Center, Nijmegen, the Departments of Cardiology (T.A.C.M.H.) and Intensive Care Medicine (W.R.), Noordwest Ziekenhuisgroep, Alkmaar, the Departments of Intensive Care Medicine (T.S.R.D.) and Cardiology (H.J.G.M.C.), Maastricht University Medical Center, Maastricht, the Department of Cardiology, Scheper Hospital, Emmen (G.A.J.J.), the Department of Cardiology, Isala Hospital, Zwolle (M.T.M.G.), the Department of Cardiology, Tergooi Hospital, Blaricum (K.P.), and the Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg (M. Magro) - all in the Netherlands.

The New England Journal of Medicine
|March 19, 2019
PubMed
Summary

Immediate coronary angiography after cardiac arrest without STEMI is not superior to delayed angiography for 90-day survival. This finding impacts treatment strategies for cardiac arrest patients, guiding decisions on urgent cardiac interventions.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Critical Care Medicine

Background:

  • Ischemic heart disease is a leading cause of out-of-hospital cardiac arrest.
  • The optimal timing for coronary angiography and percutaneous coronary intervention (PCI) in successfully resuscitated cardiac arrest patients without ST-segment elevation myocardial infarction (STEMI) is unclear.

Purpose of the Study:

  • To compare the efficacy of immediate versus delayed coronary angiography in patients resuscitated from cardiac arrest without STEMI.

Main Methods:

  • A multicenter trial randomized 552 cardiac arrest patients (no STEMI) to immediate or delayed coronary angiography.
  • Percutaneous coronary intervention (PCI) was performed as indicated.
  • The primary endpoint was 90-day survival; secondary endpoints included neurological status and organ injury.

Main Results:

  • 90-day survival was similar: 64.5% in the immediate group vs. 67.2% in the delayed group (OR, 0.89; 95% CI, 0.62-1.27; P=0.51).
  • Median time to target temperature was slightly longer in the immediate group (5.4 hours vs. 4.7 hours).
  • No significant differences were observed in secondary endpoints between the groups.

Conclusions:

  • Immediate coronary angiography does not improve 90-day survival compared to delayed angiography in cardiac arrest survivors without STEMI.
  • The findings suggest that a delayed strategy is a viable option for these patients.