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Randomized Controlled Trial
. 2021 Jul:164:93-100.
doi: 10.1016/j.resuscitation.2021.04.020. Epub 2021 Apr 28.

The effect of immediate coronary angiography after cardiac arrest without ST-segment elevation on left ventricular function. A sub-study of the COACT randomised trial

Jorrit S Lemkes  1 , Eva M Spoormans  2 , Ahmet Demirkiran  2 , Sophie Leutscher  2 , Gladys N Janssens  2 , Nina W van der Hoeven  2 , Lucia S D Jewbali  3 , Eric A Dubois  4 , Martijn Meuwissen  5 , Tom A Rijpstra  6 , Hans A Bosker  7 , Michiel J Blans  8 , Gabe B Bleeker  9 , Rémon Baak  10 , Georgios J Vlachojannis  11 , Bob J W Eikemans  12 , Pim van der Harst  13 , Iwan C C van der Horst  14 , Michiel Voskuil  15 , Joris J van der Heijden  16 , Albertus Beishuizen  17 , Martin Stoel  18 , Cyril Camaro  19 , Hans van der Hoeven  20 , José P Henriques  21 , Alexander P J Vlaar  22 , Maarten A Vink  23 , Bas van den Bogaard  24 , Ton A C M Heestermans  25 , Wouter de Ruijter  26 , Thijs S R Delnoij  27 , Harry J G M Crijns  28 , Gillian A J Jessurun  29 , Pranobe V Oemrawsingh  30 , Marcel T M Gosselink  31 , Koos Plomp  32 , Michael Magro  33 , Paul W G Elbers  34 , Peter M van de Ven  35 , Ramon B van Loon  2 , Niels van Royen  36
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Free article
Randomized Controlled Trial

The effect of immediate coronary angiography after cardiac arrest without ST-segment elevation on left ventricular function. A sub-study of the COACT randomised trial

Jorrit S Lemkes et al. Resuscitation. 2021 Jul.
Free article

Abstract

Background: The effect of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients who are successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) on left ventricular function is currently unknown.

Methods: This prespecified sub-study of a multicentre trial evaluated 552 patients, successfully resuscitated from out-of-hospital cardiac arrest without signs of STEMI. Patients were randomized to either undergo immediate coronary angiography or delayed coronary angiography, after neurologic recovery. All patients underwent PCI if indicated. The main outcomes of this analysis were left ventricular ejection fraction and end-diastolic and systolic volumes assessed by cardiac magnetic resonance imaging or echocardiography.

Results: Data on left ventricular function was available for 397 patients. The mean (± standard deviation) left ventricular ejection fraction was 45.2% (±12.8) in the immediate angiography group and 48.4% (±13.2) in the delayed angiography group (mean difference: -3.19; 95% confidence interval [CI], -6.75 to 0.37). Median left ventricular end-diastolic volume was 177 ml in the immediate angiography group compared to 169 ml in the delayed angiography group (ratio of geometric means: 1.06; 95% CI, 0.95-1.19). In addition, mean left ventricular end-systolic volume was 90 ml in the immediate angiography group compared to 78 ml in the delayed angiography group (ratio of geometric means: 1.13; 95% CI 0.97-1.32).

Conclusion: In patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, immediate coronary angiography was not found to improve left ventricular dimensions or function compared with a delayed angiography strategy.

Clinical trial registration: Netherlands Trial Register number, NTR4973.

Keywords: Coronary angiography; Left ventricular function; Out of hospital cardiac arrest; Percutaneous coronary intervention.

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Declaration of Competing Interest The authors report no declarations of interest.

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