TOMAHAWK (1-year follow-up)
Trial question
What is the role of immediate coronary angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
30.0% female
70.0% male
N = 530
530 patients (161 female, 369 male).
Inclusion criteria: patients with stable return of spontaneous circulation after out-of-hospital cardiac arrest of presumed cardiac origin but without ST-segment elevation.
Key exclusion criteria: hemodynamic or electrical instability; ST-segment elevation or new LBBB; in-hospital cardiac arrest; pregnancy.
Interventions
N=265 immediate coronary angiography (coronary angiography as soon as possible after hospital admission).
N=265 delayed or selective coronary angiography (initial intensive care assessment with coronary angiography ≥ 24 hours after hospital admission or not at all).
Primary outcome
Rate of all-cause mortality after 1 year
60.8%
54.3%
60.8 %
45.6 %
30.4 %
15.2 %
0.0 %
Immediate coronary
angiography
Delayed or selective coronary
angiography
No significant
difference ↔
No significant difference in the rate of all-cause mortality after 1 year (60.8% vs. 54.3%; HR 1.25, 95% CI 0.99 to 1.57).
Secondary outcomes
No significant difference in severe neurologic deficit in survivors at 1 year (13.5% vs. 9.2%; RR 1.47, 95% CI 0.66 to 3.26).
No significant difference in MI in survivors at 1 year (0% vs. 3%).
No significant difference in rehospitalization for congestive HF in survivors at 1 year (4.6% vs. 5%; RR 0.92, 95% CI 0.27 to 3.08).
Conclusion
In patients with stable return of spontaneous circulation after out-of-hospital cardiac arrest of presumed cardiac origin but without ST-segment elevation, immediate coronary angiography was not superior to delayed or selective coronary angiography with respect to the rate of all-cause mortality after 1 year.
Reference
Steffen Desch, Anne Freund, Ibrahim Akin et al. Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: One-Year Outcomes of a Randomized Clinical Trial. JAMA Cardiol. 2023 Sep 1;8(9):827-834.
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