COACT

Coronary Angiography after Cardiac Arrest without ST-Segment Elevation

J. Lemkes et al. New England Journal of Medicine 2019; doi:10.1056/NEJMoa1816897

Clinical Question
-  In adult patients who have sustained an out of hospital arrhythmia-associated cardiac arrest without an ST-elevation myocardial infarction, is immediate angiography superior to delayed angiography in improving 90-day survival?

N = 538, 19 centres in Netherlands

Authors’ Conclusions
-  In this randomised, multicenter trial involving patients who were successfully resuscitated after out-of-hospital cardiac arrest and who had a shockable rhythm and no signs of STEMI or a non-coronary cause of the arrest, a strategy of immediate angiography was not better than a strategy of delayed angiography with respect to overall survival at 90 days

The Bottom Line
-  In patients who have had an out of hospital cardiac arrest without ST elevation myocardial infarction, who have no evidence of cardiogenic shock or recurrent arrhythmias, a strategy of good supportive management without the need for immediate coronary intervention, would seem reasonable in most instances, based on this well-performed study.
-  I would still advocate for early angiography in patients with a good history of ischaemic symptoms prior to arrest and in those with a significant cardiac history
-  I await the publication of the ACCESS and DISCO studies to further refine my practice