COACT
Trial question
What is the role of immediate coronary angiography and PCI in patients who have been successfully resuscitated after out-of-hospital cardiac arrest in the absence of STEMI?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
23.0% female
77.0% male
N = 552
552 patients (127 female, 425 male).
Inclusion criteria: out-of-hospital cardiac arrest patients without signs of STEMI.
Key exclusion criteria: signs of STEMI on ECG, shock, noncoronary cause of arrest, severe renal dysfunction (GFR< 30 ml/min), pregnancy.
Interventions
N=273 immediate coronary angiography (initiated within 2 hours after randomization in addition to PCI, if indicated).
N=265 delayed coronary angiography (performed after neurologic recovery in addition to PCI, if indicated).
Primary outcome
Rate of survival at 90-days
64.5%
67.2%
67.2 %
50.4 %
33.6 %
16.8 %
0.0 %
Immediate coronary
angiography
Delayed coronary
angiography
No significant
difference ↔
No significant difference in the rate of survival at 90-days (64.5% vs. 67.2%; OR 0.89, 95% CI 0.62 to 1.27).
Safety outcomes
No significant difference in remaining secondary end points.
Conclusion
In out-of-hospital cardiac arrest patients without signs of STEMI, immediate coronary angiography was not superior to delayed coronary angiography with respect to the rate of survival at 90-days.
Reference
Lemkes JS, Janssens GN, van der Hoeven NW et al. Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. N Engl J Med. 2019 Apr 11;380(15):1397-1407.
Open reference URL