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
Lemkes, Jorrit S; Spoormans, Eva M; Demirkiran, Ahmet; Leutscher, Sophie; Janssens, Gladys N; van der Hoeven, Nina W; Jewbali, Lucia S D; Dubois, Eric A; Meuwissen, Martijn; Rijpstra, Tom A; Bosker, Hans A; Blans, Michiel J; Bleeker, Gabe B; Baak, Rémon; Vlachojannis, Georgios J; Eikemans, Bob J W; van der Harst, Pim; van der Horst, Iwan C C; Voskuil, Michiel; van der Heijden, Joris J; Beishuizen, Albertus; Stoel, Martin; Camaro, Cyril; van der Hoeven, Hans; Henriques, José P; Vlaar, Alexander P J; Vink, Maarten A; van den Bogaard, Bas; Heestermans, Ton A C M; de Ruijter, Wouter; Delnoij, Thijs S R; Crijns, Harry J G M; Jessurun, Gillian A J; Oemrawsingh, Pranobe V; Gosselink, Marcel T M; Plomp, Koos; Magro, Michael; Elbers, Paul W G; van de Ven, Peter M; van Loon, Ramon B; van Royen, Niels
(2021) Resuscitation, volume 164, pp. 93 - 100
(Article)
Abstract
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
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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
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Keywords: Coronary angiography, Left ventricular function, Out of hospital cardiac arrest, Percutaneous coronary intervention, Emergency, Cardiology and Cardiovascular Medicine, Emergency Medicine, Journal Article
ISSN: 0300-9572
Publisher: Elsevier Ireland Ltd
Note: Funding Information: The COACT trial was supported by unrestricted research grants from the Netherlands Heart Institute, Biotronik, and AstraZeneca. The sponsors had no role the study design, in the collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. Publisher Copyright: © 2021 The Author(s)
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