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Immediate vs Delayed Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: 5-Year Outcomes From the
Eva M Spoormans1, Gladys N Janssens1, Nina W van der Hoeven1
1Department of Cardiology, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.
Journal of the American College of Cardiology
|February 4, 2026
Summary
Five-year survival rates for out-of-hospital cardiac arrest patients were similar whether coronary angiography was immediate or delayed. This study found no significant difference in outcomes between the two strategies for cardiac arrest survivors.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Trials
Background:
- Out-of-hospital cardiac arrest (OHCA) presents a significant global health challenge.
- The Coronary Angiography After Cardiac Arrest (COACT) trial previously found no difference in 90-day survival for immediate versus delayed angiography in OHCA patients without ST-segment elevation.
- Long-term survival data comparing these strategies were previously lacking.
Purpose of the Study:
- To evaluate the 5-year survival impact of immediate versus delayed coronary angiography in OHCA patients.
- To assess outcomes in patients with initial shockable rhythm and no ST-segment elevation post-return of spontaneous circulation.
Main Methods:
- A randomized, open-label, multicenter trial (COACT) comparing immediate and delayed coronary angiography.
- 514 patients with OHCA without ST-segment elevation were followed for 5 years via telephone interviews.
- Secondary endpoints included myocardial infarction, repeat revascularization, heart failure hospitalizations, and defibrillator shocks.
Main Results:
- At 5-year follow-up, 54.8% of patients in the immediate angiography group and 51.8% in the delayed group were alive (HR: 0.95; 95% CI: 0.74-1.23).
- Exploratory analysis suggested a potential survival benefit after 90 days in the delayed group (HR: 0.56; 95% CI: 0.32-0.97), though its significance is uncertain.
- Rates of myocardial infarction, heart failure hospitalizations, and revascularization did not differ between the groups.
Conclusions:
- Five-year survival rates were comparable between immediate and delayed coronary angiography strategies in OHCA patients without ST-segment elevation.
- No clear short-term or long-term benefit or harm was identified for either strategy.
- The observed late survival benefit in the exploratory analysis warrants caution and may be due to chance.
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