Immediate vs. delayed angiography in NSTEMI patients after cardiac arrest did not improve survival at 1 year
One-Year Outcomes of Coronary Angiography after Cardiac Arrest without ST Segment Elevation. Results of the COACT trial
Presented during the AHA Scientific Sessions 2019 by Jorrit Lemkes (Amsterdam, The Netherlands).
Introduction and methods
Guidelines recommend immediate coronary angiography with PCI in patients presenting with STEMI and cardiac arrest. In patients with cardiac arrest and non-ST elevation MI, guidelines recommend emergency angiography, but evidence from RCTs is lacking.
The COACT trial was a randomized trial that examine whether immediate angiography was associated with improved survival when compared to delayed angiography in 552 patients successfully resuscitated from out of hospital cardiac arrest in the absence of ST segment elevation. The primary endpoint of survival at 90 days was not different between groups (64.7% for immediate angiography and 67.2% for delayed angiography). However, effects of early angiography on long-term outcomes are unknown and observational studies suggest that early CABG results in benefits on long-term mortality.
This study examined the survival in the immediate angiography group vs. the delayed angiography group after 1 year. Only 3 patients were lost to follow-up.
- After 1 year, survival was not different between the groups (61.4% in the immediate vs 64% in the delayed group, HR: 0.90, 95%CI:0.63-1.28).
- Event rates of secondary outcomes were low (MI, any revascularization, any PCI, any CABG, hospitalization due to HF, ICD shock) and were not different between the two groups.
- Physical and mental summary scores (RAND-36 questionnaire) were not different between the two groups.
In patients after cardiac arrest without signs of STEMI, immediate coronary angiography did not result in improved survival at 1 year compared to delayed angiography.
- Our reporting is based on the information provided during AHA Scientific Sessions 2019 -