• Jorrit S Lemkes, Gladys N Janssens, Heleen M Oudemans-van Straaten, Paul W Elbers, Nina W van der Hoeven, Jan G P Tijssen, Luuk C Otterspoor, Michiel Voskuil, Joris J van der Heijden, Martijn Meuwissen, Tom A Rijpstra, Georgios J Vlachojannis, Raoul M van der Vleugel, Koen Nieman, Lucia S D Jewbali, Gabe B Bleeker, Rémon Baak, Bert Beishuizen, Martin G Stoel, Pim van der Harst, Cyril Camaro, José P S Henriques, Maarten A Vink, Gosselink Marcel T M MT Department of Cardiology, Isala klinieken, Zwolle, the Netherlands., Hans A Bosker, Harry J G M Crijns, Niels van Royen, and COACT investigators.
• Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands. Electronic address: j.lemkes@vumc.nl.
• Am. Heart J. 2016 Oct 1; 180: 39-45.

BackgroundIschemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI) after restoration of spontaneous circulation following cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains debated.HypothesisWe hypothesize that immediate CAG and PCI, if indicated, will improve 90-day survival in post-cardiac arrest patients without signs of STEMI.DesignIn a prospective, multicenter, randomized controlled clinical trial, 552 post-cardiac arrest patients with restoration of spontaneous circulation and without signs of STEMI will be randomized in a 1:1 fashion to immediate CAG and PCI (within 2 hours) versus initial deferral with CAG and PCI after neurological recovery. The primary end point of the study is 90-day survival. The secondary end points will include 90-day survival with good cerebral performance or minor/moderate disability, myocardial injury, duration of inotropic support, occurrence of acute kidney injury, need for renal replacement therapy, time to targeted temperature control, neurological status at intensive care unit discharge, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, and reasons for discontinuation of treatment.SummaryThe COACT trial is a multicenter, randomized, controlled clinical study that will evaluate the effect of an immediate invasive coronary strategy in post-cardiac arrest patients without STEMI on 90-day survival.Copyright © 2016 Elsevier Inc. All rights reserved.

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