What question did this study set out to answer?

To compare the effect of immediate versus delayed or selective coronary angiography on 1-year survival in patients resuscitated from out-of-hospital cardiac arrest without ST-segment elevation, and to identify potential subgroup-specific treatment effects.

May 28, 2025JAMA CardiologyOpen Access

One-Year Outcomes of Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST Elevation

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Why the study?

Randomized trials found no difference in short-term survival between immediate and delayed coronary angiography after OHCA without ST-segment elevations, but long-term outcomes and potential subgroup benefits remained unclear.

Does immediate coronary angiography improve 1-year survival in successfully resuscitated patients with out-of-hospital cardiac arrest without ST-segment elevations compared to delayed or selective coronary angiography?

Population

1031 patients with OHCA without ST-segment elevations from 2 RCTs

Comparison

Immediate vs delayed or selective coronary angiography

Design

1-stage individual participant data meta-analysis of 2 RCTs

Follow-up

1 year

Authors

ESEva M. SpoormansAmsterdam University Medical Centers TTTharusan ThevathasanDeutsches Herzzentrum der Charité NRNiels van RoyenInterventional / Structural Cardiology

Discussion

Member takes

Implication

No 1-year survival difference with immediate vs delayed angiography; extends short-term RCT null findings without clarifying subgroups.

Key Points

To compare the effect of immediate versus delayed or selective coronary angiography on 1-year survival in patients resuscitated from out-of-hospital cardiac arrest without ST-segment elevation, and to identify potential subgroup-specific treatment effects.
One-stage individual participant data meta-analysis combining two randomized clinical trials (COACT and TOMAHAWK; PROSPERO CRD42022346559, NTR4973, NCT02750462).
Analyzed 1031 patients resuscitated after out-of-hospital cardiac arrest without ST-segment elevations randomized to immediate coronary angiography (n=522) or delayed/selective coronary angiography (n=509) across a 1-year follow-up period.
At 1 year, survival occurred in 259 of 522 patients (49.6%) in the immediate angiography group versus 272 of 509 patients (53.4%) in the delayed or selective angiography group (hazard ratio, 1.15; 95% CI, 0.96-1.37).
Subgroup analyses revealed no significant treatment-by-subgroup interactions based on age, sex, arrest rhythm, or clinical history, with interaction P values ranging from P = .26 to P = .91.

Structured PICO

Population

1031 successfully resuscitated patients with out-of-hospital cardiac arrest (OHCA) without ST-segment elevations and in absence of an obvious noncoronary cause of the arrest, median age 68, ~75% male. Data pooled from 2 RCTs (COACT and TOMAHAWK). Excluded patients with hemodynamic or electrical instability who required urgent reperfusion therapy.

Intervention

Immediate coronary angiography

Comparator

Delayed or selective coronary angiography

Outcome

1-year survivalhard clinical

Immediate coronary angiography does not improve 1-year survival compared with a delayed or selective strategy in successfully resuscitated patients with out-of-hospital cardiac arrest without ST-segment elevations.

Cite This Study

Spoormans et al. (2025) studied this question.

synapsesocial.com/papers/6a7cfb0d9b79cb18d5cd8eb0 https://doi.org/10.1001/jamacardio.2025.1194

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One-Year Outcomes of Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST Elevation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

One-Year Outcomes of Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST Elevation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

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