Is emergency coronary angiogram required in cardiac arrest patients without ST-segment elevation?

The 180-day survival rate with a CPC of 2 or below was the main outcome. Secondary endpoints included the occurrence of shock, ventricular tachycardia, and/or fibrillation within 48 hours, the change in left ventricular ejection fraction between baseline and 180 days, the CPC scale at ICU discharge and day 90, the chance of survival, and the length of stay in the hospital.

The key findings of this study were as follows:

1. There were 279 individuals in the immediate CAG group and 138 (49.5%) in the delayed CAG group.

2. The mean (SD) time delay between randomized and CAG in the emergency CAG group was 0.6 (3.7) hours and 55.1 (37.2) hours in the delayed CAG group.

3. The emergency CAG group had a 34.1% (47 of 141) 180-day survival rate while the delayed CAG group had a 30.7% (42 of 138) survival rate.

4. There was no difference between the two groups in terms of overall survival at 180 days or secondary outcomes.

In conclusion, the authors found that the findings of this study were consistent with prior research and do not justify immediate CAG in OHCA patients without ST elevation.

Reference:

Hauw-Berlemont C, Lamhaut L, Diehl J, et al. Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial. JAMA Cardiol. Published online June 08, 2022. doi:10.1001/jamacardio.2022.1416