Why does it matter?

Heart disease is a major cause of out-of-hospital cardiac arrest. However, the benefit of PCI is unclear in the absence of STEMI post resuscitation.

Methods:

• Multicenter trial involving 552 patients resuscitated after cardiac arrest without STEMI at 19 centers in the Netherlands.
• 538 patients (97.5%) had data available for assessment; 273 had immediate angiography and 265 had delayed angiography performed.
• Primary end-point: Survival at 90 days
• Secondary end-points: Survival at 90 days with good cerebral performance or mild or moderate disability, myocardial injury, duration of catecholamine support, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, major bleeding, occurrence of acute kidney injury, need for renal-replacement therapy, time to target temperature, and neurologic status at discharge from the intensive care unit.

Results:

At 90 days, 176 of 273 patients (64.5%) in the immediate angiography group and 178 of 265 patients (67.2%) in the delayed angiography group were alive (odds ratio, 0.89; 95% confidence interval [CI], 0.62 to 1.27; P = 0.51).

Conclusion: Immediate angiography was NOT found to be better than delayed angiography in regards to overall survival at 90 days.

Strengths: 

• Clear, focused question
• Strong internal validity
• Similar groups
• Good method and clear protocol (prior to trial) that was not altered
• High rate of follow up

Limitations:

• Data acquired only in the final phase (90 days after randomization)
• Exclusions from study: shock, severe renal disease, pregnancy, obvious non-coronary cause of arrest, suspected stroke or ICH
• The rate of unstable and acute thrombotic lesions in this population was much lower than in populations from previous observational studies.

Reference: Lemkes JS, et al. Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. N Engl J Med. 2019 Apr 11;380(15):1397-1407. doi: 10.1056/NEJMoa1816897