Immediate angiography after out-of-hospital cardiac arrest without ST-segment elevation of no benefit: NEJM
USA: Early angiography shows no benefit over a delayed or selective strategy with regards to the 30-day risk of death from any cause in patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation, finds a recent study. The study findings were published in the New England Journal of Medicine on August 29, 2021.
Myocardial infarction (MI) is a common cause of lead to out-of-hospital cardiac arrest. Steffen Desch and colleagues aimed to determine the benefits of early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST segment elevation
The multicenter trial included 554 patients with successfully resuscitated out-of-hospital cardiac arrest of possible coronary origin. They were randomly assigned to undergo either immediate coronary angiography (immediate-angiography group) or initial intensive care assessment with delayed or selective angiography (delayed-angiography group). The patients had no evidence of ST-segment elevation on post-resuscitation electrocardiography.
The primary endpoint was death from any cause at 30 days. Secondary endpoints included a composite of death from any cause or severe neurologic deficit at 30 days.
A total of 530 of 554 patients (95.7%) were included in the primary analysis.
Key findings of the study include:
- 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).
- 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.
- 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.
The researchers concluded, "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."
Reference:
The study titled, "Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation," is published in the New England Journal of Medicine.
DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2101909
