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Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Steffen Desch
  • Anne Freund
  • Ibrahim Akin
  • Michael Behnes
  • Michael R. Preusch
  • Thomas A. Zelniker
  • Carsten Skurk
  • Ulf Landmesser
  • Tobias Graf
  • Ingo Eitel
  • Georg Fuernau
  • Hendrik Haake
  • Peter Nordbeck
  • Fabian Hammer
  • Stephan B. Felix
  • Hassager, Christian
  • Engstrøm, Thomas
  • Stephan Fichtlscherer
  • Jakob Ledwoch
  • Karsten Lenk
  • Michael Joner
  • Stephan Steiner
  • Christoph Liebetrau
  • Ingo Voigt
  • Uwe Zeymer
  • Michael Brand
  • Roland Schmitz
  • Jan Horstkotte
  • Claudius Jacobshagen
  • Janine Poss
  • Mohamed Abdel-Wahab
  • Philipp Lurz
  • Alexander Jobs
  • Suzanne de Waha-Thiele
  • Denise Olbrich
  • Frank Sandig
  • Inke R. Koenig
  • Sabine Brett
  • Maren Vens
  • Kathrin Klinge
  • Holger Thiele
  • TOMAHAWK Investigators

Background

Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest. However, the benefits of early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST-segment elevation are unclear.

Methods

In this multicenter trial, we randomly assigned 554 patients with successfully resuscitated out-of-hospital cardiac arrest of possible coronary origin to undergo either immediate coronary angiography (immediate-angiography group) or initial intensive care assessment with delayed or selective angiography (delayed-angiography group). All the patients had no evidence of ST-segment elevation on postresuscitation electrocardiography. The primary end point was death from any cause at 30 days. Secondary end points included a composite of death from any cause or severe neurologic deficit at 30 days.

Results

A total of 530 of 554 patients (95.7%) were included in the primary analysis. At 30 days, 143 of 265 patients (54.0%) in the immediate-angiography group and 122 of 265 patients (46.0%) in the delayed-angiography group had died (hazard ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.63; P=0.06). The composite of death or severe neurologic deficit occurred more frequently in the immediate-angiography group (in 164 of 255 patients [64.3%]) than in the delayed-angiography group (in 138 of 248 patients [55.6%]), for a relative risk of 1.16 (95% CI, 1.00 to 1.34). Values for peak troponin release and for the incidence of moderate or severe bleeding, stroke, and renal-replacement therapy were similar in the two groups.

Conclusions

Among patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation, a strategy of performing immediate angiography provided no benefit over a delayed or selective strategy with respect to the 30-day risk of death from any cause.

OriginalsprogEngelsk
TidsskriftNew England Journal of Medicine
Antal sider10
ISSN0028-4793
DOI
StatusE-pub ahead of print - 2021

ID: 279628863