TY - JOUR
T1 - Clinical paper The effect of immediate coronary angiography after cardiac arrest without ST-segment elevation on left ventricular function. A sub-study of the COACT randomised trial
AU - Lemkes, Jorrit S.
AU - Spoormans, Eva M.
AU - Demirkiran, Ahmet
AU - Leutscher, Sophie
AU - Janssens, Gladys N.
AU - van der Hoeven, Nina W.
AU - Jewbali, Lucia S. D.
AU - Dubois, Eric A.
AU - Meuwissen, Martijn
AU - Rijpstra, Tom A.
AU - Bosker, Hans A.
AU - Blans, Michiel J.
AU - Bleeker, Gabe B.
AU - Baak, Remon
AU - Vlachojannis, Georgios J.
AU - Eikemans, Bob J. W.
AU - van der Harst, Pim
AU - van der Horst, Iwan C. C.
AU - Voskuil, Michiel
AU - van der Heijden, Joris J.
AU - Beishuizen, Albertus
AU - Stoel, Martin
AU - Camaro, Cyril
AU - van der Hoeven, Hans
AU - Henriques, Jose P.
AU - Vlaar, Alexander P. J.
AU - Vink, Maarten A.
AU - van den Bogaard, Bas
AU - Heestermans, Ton A. C. M.
AU - de Ruijter, Wouter
AU - Delnoij, Thijs S. R.
AU - Crijns, Harry J. G. M.
AU - Jessurun, Gillian A. J.
AU - Oemrawsingh, Pranobe V.
AU - Gosselink, Marcel T. M.
AU - Plomp, Koos
AU - Magro, Michael
AU - Elbers, Paul W. G.
AU - van de Ven, Peter M.
AU - van Loon, Ramon B.
AU - van Royen, Niels
PY - 2021/7
Y1 - 2021/7
N2 - Background: The effect of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients who are successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) on left ventricular function is currently unknown.Methods: This prespecified sub-study of a multicentre trial evaluated 552 patients, successfully resuscitated from out-of-hospital cardiac arrest without signs of STEMI. Patients were randomized to either undergo immediate coronary angiography or delayed coronary angiography, after neurologic recovery. All patients underwent PCI if indicated. The main outcomes of this analysis were left ventricular ejection fraction and end-diastolic and systolic volumes assessed by cardiac magnetic resonance imaging or echocardiography.Results: Data on left ventricular function was available for 397 patients. The mean (+/- standard deviation) left ventricular ejection fraction was 45.2% (+/- 12.8) in the immediate angiography group and 48.4% (+/- 13.2) in the delayed angiography group (mean difference:-3.19; 95% confidence interval [CI],-6.75 to 0.37). Median left ventricular end-diastolic volume was 177 ml in the immediate angiography group compared to 169 ml in the delayed angiography group (ratio of geometric means: 1.06; 95% CI, 0.95-1.19). In addition, mean left ventricular end-systolic volume was 90 ml in the immediate angiography group compared to 78 ml in the delayed angiography group (ratio of geometric means: 1.13; 95% CI 0.97-1.32).Conclusion: In patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, immediate coronary angiography was not found to improve left ventricular dimensions or function compared with a delayed angiography strategy.Clinical Trial Registration: Netherlands Trial Register number, NTR4973
AB - Background: The effect of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients who are successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) on left ventricular function is currently unknown.Methods: This prespecified sub-study of a multicentre trial evaluated 552 patients, successfully resuscitated from out-of-hospital cardiac arrest without signs of STEMI. Patients were randomized to either undergo immediate coronary angiography or delayed coronary angiography, after neurologic recovery. All patients underwent PCI if indicated. The main outcomes of this analysis were left ventricular ejection fraction and end-diastolic and systolic volumes assessed by cardiac magnetic resonance imaging or echocardiography.Results: Data on left ventricular function was available for 397 patients. The mean (+/- standard deviation) left ventricular ejection fraction was 45.2% (+/- 12.8) in the immediate angiography group and 48.4% (+/- 13.2) in the delayed angiography group (mean difference:-3.19; 95% confidence interval [CI],-6.75 to 0.37). Median left ventricular end-diastolic volume was 177 ml in the immediate angiography group compared to 169 ml in the delayed angiography group (ratio of geometric means: 1.06; 95% CI, 0.95-1.19). In addition, mean left ventricular end-systolic volume was 90 ml in the immediate angiography group compared to 78 ml in the delayed angiography group (ratio of geometric means: 1.13; 95% CI 0.97-1.32).Conclusion: In patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, immediate coronary angiography was not found to improve left ventricular dimensions or function compared with a delayed angiography strategy.Clinical Trial Registration: Netherlands Trial Register number, NTR4973
KW - Out of hospital cardiac arrest
KW - Coronary angiography
KW - Percutaneous coronary intervention
KW - Left ventricular function
KW - TARGETED TEMPERATURE MANAGEMENT
KW - MYOCARDIAL-INFARCTION
KW - SURVIVORS
KW - ASSOCIATION
KW - SOCIETY
KW - IMPACT
U2 - 10.1016/j.resuscitation.2021.04.020
DO - 10.1016/j.resuscitation.2021.04.020
M3 - Article
SN - 0300-9572
VL - 164
SP - 93
EP - 100
JO - Resuscitation
JF - Resuscitation
ER -