Highlights from

AHA 2019

American Heart Association’s Scientific Sessions

Philadelphia, USA 16 - 18 November 2019

Immediate Coronary Angiography After Cardiac Arrest Does Not Improve Survival

Immediate coronary angiography after cardiac arrest did not improve survival at 1 year compared with a strategy of delayed procedure in patients successfully resuscitated from out of hospital cardiac arrest (OHCA) in the absence of ST segment elevation (STE).

Dr Jorrit Lemkes (Amsterdam University Medical Center, the Netherlands) presented the 1-year clinical outcome data from the Coronary Angiography after Cardiac Arrest (COACT) trial [1]. COACT is the first randomised study to analyse whether immediate versus delayed invasive strategy improves survival and major adverse cardiac events at 1 year in cardiac arrest patients without STE. The investigator-initiated, open-label, multicentre trial enrolled 552 OHCA patients with return of spontaneous circulation (ROSC) and without STE. Patients were randomised 1:1 to receive either immediate angiography (n=264) or delayed angiography (n=258).

The primary endpoint was survival at 90 days, with short-term secondary endpoints including survival at 90 days with good cerebral performance or moderate disability, thrombolysis in myocardial infarction major bleeding, recurrence of ventricular tachycardia, occurrence of acute kidney injury, and need for renal-replacement therapy, time-to-target temperature, duration of inotropic/catecholamine support, duration of mechanical ventilation, myocardial injury, and markers of shock.

The results did not indicate improvement; 61.4% of patients in the immediate angiography group and 64.0% of patients in the delayed group were alive 1-year post-cardiac arrest (OR 0.90; 95% CI 0.63-1.28). Additionally, no significant differences were observed in the rates of myocardial infarction, revascularisation, hospitalisation due to heart failure, or ICD shocks between the 2 treatment groups at 1 year.

At 1 year, 2 out of 264 (0.8%) patients and 1 out of 258 (0.4%) patients suffered myocardial infarction in the immediate and delayed groups, respectively. The rate of any revascularisation since index hospitalisation was also similar across both groups, with 10/264 (3.8%) and 10/258 (3.9%) in the immediate and delayed groups, respectively.

  1. Lemkes J, et al. One Year Outcomes of Coronary Angiography After Cardiac Arrest. Session LBS04. American Heart Association Annual Scientific Sessions (AHA 2019), 14-18 November, Philadelphia, PA, USA.

Top image: @ iStockPhoto: Noctiluxx

The content and interpretation of these conference highlights are the views and comments of the speakers/authors.