• Resuscitation · Jul 2021

    Randomized Controlled Trial Multicenter Study

    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.

    • Jorrit S Lemkes, Eva M Spoormans, Ahmet Demirkiran, Sophie Leutscher, Gladys N Janssens, Nina W van der Hoeven, JewbaliLucia S DLSDDepartment of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands., Eric A Dubois, Martijn Meuwissen, Tom A Rijpstra, Hans A Bosker, Michiel J Blans, Gabe B Bleeker, Rémon Baak, Georgios J Vlachojannis, EikemansBob J WBJWDepartment of Intensive Care Medicine, Maasstad Hospital, Rotterdam, The Netherlands., Pim van der Harst, van der HorstIwan C CICCUniversity of Groningen, University Medical Centre Groningen, Department of Intensive Care Medicine, Groningen, The Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Centre, University Maastricht, Ma, Michiel Voskuil, Joris J van der Heijden, Albertus Beishuizen, Martin Stoel, Cyril Camaro, Hans van der Hoeven, José P Henriques, VlaarAlexander P JAPJDepartment of Intensive Care Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands., Maarten A Vink, Bas van den Bogaard, Ton A C M Heestermans, Wouter de Ruijter, DelnoijThijs S RTSRDepartment of Intensive Care Medicine, Maastricht University Medical Centre, University Maastricht, Maastricht, The Netherlands., CrijnsHarry J G MHJGMDepartment of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands., JessurunGillian A JGAJDepartment of Cardiology, Scheper Hospital, Emmen, The Netherlands., Pranobe V Oemrawsingh, Marcel T M Gosselink, Koos Plomp, Michael Magro, ElbersPaul W GPWGDepartment of Intensive Care Medicine, Amsterdam University Medical Centre, Location VUmc, Amsterdam, The Netherlands., Peter M van de Ven, Ramon B van Loon, and Niels van Royen.
    • Department of Cardiology, Amsterdam University Medical Centre, Location VUmc, Amsterdam, The Netherlands. Electronic address: j.lemkes@amsterdamumc.nl.
    • Resuscitation. 2021 Jul 1; 164: 93-100.

    BackgroundThe 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.MethodsThis 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.ResultsData 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).ConclusionIn 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 RegistrationNetherlands Trial Register number, NTR4973.Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

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