Immediate Coronary Angiography After Cardiac Arrest Does Not Improve 1-Year Survival
By Walter Alexander
PHILADELPHIA -- November 19, 2019 -- Compared with delayed coronary angiography, immediate coronary angiography did not improve1-year survival after out-of-hospital cardiac arrest, according to a study presented here at the 2019 American Heart Association (AHA) Scientific Sessions.
In addition, there was no significant difference in 1-year rates of myocardial infarction (MI), revascularisation, hospitalisation due to heart failure or implantable cardioverter-defibrillator shocks between the delayed and immediate angiography groups, reported Jorrit Lemkes, MD, Vrije Universiteit, Amsterdam, the Netherlands.
Current guidelines recommend immediate coronary angiography with percutaneous coronary intervention in patients who present with ST-elevation MI and cardiac arrest, and emergency angiography among patients with cardiac arrest without ST-elevation. However, this latter recommendation is based only on observational data.
The Coronary Angiography After Cardiac Arrest (COACT) trial compared immediate versus delayed coronary angiography in patients successfully resuscitated from out-of-hospital cardiac arrest in the absence of ST-segment elevation.
A total of 552 patients who experienced an out-of-hospital cardiac arrest without ST-segment elevation were randomised 1:1 to an immediate or a delayed invasive strategy. Median time from cardiac arrest to coronary angiography was 2.1 hours in the immediate angiography group and 121.4 hours in the delayed angiography group.
Survival at 1-year was 61.4% in the immediate angiography group and 64.0% in the delayed angiography group.
Rates of MI, revascularisation, hospitalisation due to heart failure or implantable cardioverter-defibrillator shocks were also similar between the groups at 1 year.
“COACT results show that while angiography remains essential, early angiography does not improve outcomes compared with delayed angiography,” commented Joaquin E. Cigarroa, MD, Oregon Health and Sciences University, Portland, Oregon. “These findings should not be surprising given the lack of difference in myocardial injury, nor evidence of reduction in ischaemia, duration of inotropic support, temperature targeted management during the index hospitalisation, and concordant primary and secondary outcomes at 90 days.”
[Presentation title: One-Year Outcomes of Coronary Angiography After Cardiac Arrest. LBS.04]