What question did this study set out to answer?

To compare 1-year clinical outcomes between immediate unselective coronary angiography and a delayed or selective invasive approach in patients successfully resuscitated from out-of-hospital cardiac arrest without ST-segment elevation.

August 9, 2023JAMA CardiologyOpen Access

Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation

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Authors

SDSteffen DeschInterventional Cardiology AFAnne FreundUniversität Hamburg İAİbrahim AkınInterventional Cardiology

Discussion

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Implication

Randomized trial finds no survival benefit for immediate coronary angiography in cardiac arrest patients without ST elevation, indicating routine emergency catheterization may not be needed.

Key Points

To compare 1-year clinical outcomes between immediate unselective coronary angiography and a delayed or selective invasive approach in patients successfully resuscitated from out-of-hospital cardiac arrest without ST-segment elevation.
International, multicenter (Germany and Denmark), open-label randomized clinical trial (TOMAHAWK, NCT02750462) enrolling 554 patients resuscitated from out-of-hospital cardiac arrest of presumed cardiac origin without ST-segment elevation.
Participants were randomly assigned to immediate coronary angiography upon admission (n=281) or initial intensive care evaluation with delayed or selective angiography after at least 24 hours (n=273).
All 554 patients were followed for 1 year to evaluate all-cause mortality, as well as secondary outcomes including severe neurologic deficit, myocardial infarction, and heart failure rehospitalization among survivors.
All-cause mortality at 1 year was 60.8% (161 of 265) in the immediate angiography arm compared with 54.3% (144 of 265) in the delayed or selective angiography arm (hazard ratio, 1.25; 95% CI, 0.99-1.57; P = .05).
Among participants surviving to 1 year, rates of severe neurologic deficit, recurrent myocardial infarction, and rehospitalization for congestive heart failure did not significantly differ between the treatment strategies.

Cite This Study

Desch et al. (2023) studied this question.

synapsesocial.com/papers/6a9ca80c48effd99aa57a9b8 https://doi.org/10.1001/jamacardio.2023.2264

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Implication

Randomized trial finds no survival benefit for immediate coronary angiography in cardiac arrest patients without ST elevation, indicating routine emergency catheterization may not be needed.

Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation

Discussion

Member takes

Implication

Key Points

Cite This Study

Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation

Discussion

Member takes

Implication

Key Points

Cite This Study

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