Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation
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, Christian Hassager, Thomas Engstrøm, 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 Pöss, Mohamed Abdel-Wahab, Philipp Lurz, Alexander Jobs, Suzanne de Waha-Thiele, Denise Olbrich, Frank Sandig, Inke R König, Sabine Brett, Maren Vens, Kathrin Klinge, Holger Thiele, TOMAHAWK Investigators, Steffen Desch, Anne Freund, Holger Thiele, Kathrin Klinge, Sabine Brett, Inke R König, Maren Vens, Frank Sandig, Ulrich Tebbe, Michael Oeff, Karl Georg Häusler, Guido Michels, Karl Werdan, Joachim Gerß, Ibrahim Akin, Michael Behnes, Uzair Ansari, Michael R Preusch, Jan Stiepak, Tobias Graf, Karolin Schmoll, Georg Fuernau, Thomas Stiermaier, Ingo Eitel, Suzanne de Waha-Thiele, Ulf Landmesser, Carsten Skurk, Thomas Wurster, Wulf Knie, Hendrik Haake, Jürgen Vom Dahl, Christian Kotzlowski, Peter Nordbeck, Octavian Maniuc, Maria Moritz, Fabian Hammer, Stephan B Felix, Peter Abel, Daniel Beug, Christian Hassager, Jesper Kjaergaard, Thomas Engstrøm, Stephan Fichtlscherer, Mariuca Vasa-Nicotera, Stephan Heyl, Jakob Ledwoch, Christian Kupatt, Petra Hoppmann, Christian Bradaric, Karsten Lenk, Ulrich Laufs, Daniel Lavall, Michael Joner, Patrick Mayr, Anna-Lena Lahmann, Janine Pöss, Mohamed Abdel-Wahab, Philipp Lurz, Alexander Jobs, Stephan Steiner, Stefanie Weigel, Christoph Liebetrau, Maren Weferling, Catharina Hamm, Ingo Voigt, Thomas Schmitz, Uwe Zeymer, Ralph Winkler, Michael Brand, Hans-Joachim Trappe, Roland Schmitz, Christian Valina, Simon Schöchlin, Christoph Garlichs, Jan Horstkotte, Claudius Jacobshagen, Tim Seidler, Gerd Hasenfuß, Sylvia Otto, Sven Möbius-Winkler, P Christian Schulze, Tommaso Gori, Stephan Kische, Peter Grewe, Klaus Pels, Stefan Sack, Harald Mudra, Niels Menck, Norman Klöppner, Stefan Löser, Philipp Lauten, Axel Linke, Norman Mangner, Felix Woitek, Derk Frank, Matthias Lutz, Norbert Frey, Tobias Geisler, Michal Droppa, Marc-Alexander Ohlow, 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, Christian Hassager, Thomas Engstrøm, 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 Pöss, Mohamed Abdel-Wahab, Philipp Lurz, Alexander Jobs, Suzanne de Waha-Thiele, Denise Olbrich, Frank Sandig, Inke R König, Sabine Brett, Maren Vens, Kathrin Klinge, Holger Thiele, TOMAHAWK Investigators, Steffen Desch, Anne Freund, Holger Thiele, Kathrin Klinge, Sabine Brett, Inke R König, Maren Vens, Frank Sandig, Ulrich Tebbe, Michael Oeff, Karl Georg Häusler, Guido Michels, Karl Werdan, Joachim Gerß, Ibrahim Akin, Michael Behnes, Uzair Ansari, Michael R Preusch, Jan Stiepak, Tobias Graf, Karolin Schmoll, Georg Fuernau, Thomas Stiermaier, Ingo Eitel, Suzanne de Waha-Thiele, Ulf Landmesser, Carsten Skurk, Thomas Wurster, Wulf Knie, Hendrik Haake, Jürgen Vom Dahl, Christian Kotzlowski, Peter Nordbeck, Octavian Maniuc, Maria Moritz, Fabian Hammer, Stephan B Felix, Peter Abel, Daniel Beug, Christian Hassager, Jesper Kjaergaard, Thomas Engstrøm, Stephan Fichtlscherer, Mariuca Vasa-Nicotera, Stephan Heyl, Jakob Ledwoch, Christian Kupatt, Petra Hoppmann, Christian Bradaric, Karsten Lenk, Ulrich Laufs, Daniel Lavall, Michael Joner, Patrick Mayr, Anna-Lena Lahmann, Janine Pöss, Mohamed Abdel-Wahab, Philipp Lurz, Alexander Jobs, Stephan Steiner, Stefanie Weigel, Christoph Liebetrau, Maren Weferling, Catharina Hamm, Ingo Voigt, Thomas Schmitz, Uwe Zeymer, Ralph Winkler, Michael Brand, Hans-Joachim Trappe, Roland Schmitz, Christian Valina, Simon Schöchlin, Christoph Garlichs, Jan Horstkotte, Claudius Jacobshagen, Tim Seidler, Gerd Hasenfuß, Sylvia Otto, Sven Möbius-Winkler, P Christian Schulze, Tommaso Gori, Stephan Kische, Peter Grewe, Klaus Pels, Stefan Sack, Harald Mudra, Niels Menck, Norman Klöppner, Stefan Löser, Philipp Lauten, Axel Linke, Norman Mangner, Felix Woitek, Derk Frank, Matthias Lutz, Norbert Frey, Tobias Geisler, Michal Droppa, Marc-Alexander Ohlow
Abstract
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. (Funded by the German Center for Cardiovascular Research; TOMAHAWK ClinicalTrials.gov number, NCT02750462.).
Copyright © 2021 Massachusetts Medical Society.
Source: PubMed