Immediate vs Delayed Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: 5-Year Outcomes From the COACT Randomized Trial.
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Spoormans Eva M, Janssens Gladys N, van der Hoeven Nina W, Jewbali Lucia S D, Dubois Eric A, Meuwissen Martijn, Rijpstra Tom A, Bosker Hans A, Blans Michiel J, Bleeker Gabe B, Baak Remon, Vlachojannis Georgios J, Eikemans Bob J W, van der Harst Pim, van der Horst Iwan C C, Voskuil Michiel, van der Heijden Joris J, Beishuizen Albertus, Stoel Martin, Camaro Cyril, van der Hoeven Hans, Henriques José P, Vlaar Alexander P J, Vink Maarten A, van den Bogaard Bas, Heestermans Ton A C M, de Ruijter Wouter, Delnoij Thijs S R, Crijns Harry J G M, Oemrawsingh Pranobe V, Gosselink Marcel T M, Plomp Koos, Magro Michael, Elbers Paul W G, Zwinderman Aeilko H, van Royen Niels, Lemkes Jorrit S
Аннотация
OBJECTIVES: The aim of this study was to investigate the 5-year impact on survival of immediate vs delayed coronary angiography in OHCA patients with an initial shockable rhythm and no ST-segment elevation on initial electrocardiography after return of spontaneous circulation.
METHODS: The COACT trial was a randomized, open-label, multicenter study comparing immediate vs delayed coronary angiography in patients resuscitated from OHCA without ST-segment elevation. Nineteen Dutch centers enrolled patients, and 5-year follow-up was obtained via structured telephone interviews. Secondary endpoints included myocardial infarction, repeat revascularization, heart failure-related hospitalizations, and implantable cardioverter-defibrillator shocks.
RESULTS: At 5-year follow-up, data from 514 of 552 patients (93.1%) were available. Of these patients, 261 (50.8%) were assigned to immediate angiography and 253 (49.2%) to a delayed strategy. Baseline characteristics were similar across the 2 treatment groups. Five years after the index hospitalization, 143 patients (54.8%) were alive in the immediate angiography group, and 131 patients (51.8%) were alive in the delayed angiography group (HR: 0.95; 95% CI: 0.74-1.23; log-rank P = 072). In a nonprespecified and exploratory landmark analysis, HRs for death to 90 days and >90 days were 1.11 (95% CI: 0.84-1.49; log-rank P = 0.46) and 0.56 (95% CI: 0.32-0.97; log-rank P = 0.04). Rates of myocardial infarction, heart failure-related hospitalization, and revascularization were low and did not differ between groups.
CONCLUSIONS: At 5 years, survival was comparable between immediate and delayed angiography, with no clear benefit or harm. A late survival benefit appeared after 90 days, though its clinical significance remains uncertain and most likely is due to chance. (Coronary Angiography After Cardiac Arrest [COACT]; NTR4973).