Coronary angiography after cardiac arrest without ST-segment elevation

Jorrit S. Lemkes, Gladys N. Janssens, Nina W. van der Hoeven, Lucia S. D. Jewbali, Eric A. Dubois, Martijn Meuwissen, Tom A. Rijpstra, Hans A. Bosker, Michiel J. Blans, Gabe B. Bleeker, R. mon Baak, Georgios J. Vlachojannis, Bob J. W. Eikemans, Pim van der Harst, Iwan C. C. van der Horst, Michiel Voskuil, Joris J. van der Heijden, Albertus Beishuizen, Martin Stoel, Cyril Camaro & 18 others Hans van der Hoeven, José P. Henriques, Alexander P. J. Vlaar, Maarten A. Vink, Bas van den Bogaard, Ton A. C. M. Heestermans, Wouter de Ruijter, Thijs S. R. Delnoij, Harry J. G. M. Crijns, Gillian A. J. Jessurun, Pranobe V. Oemrawsingh, Marcel T. M. Gosselink, Koos Plomp, Michael Magro, Paul W. G. Elbers, Peter M. van de Ven, Heleen M. Oudemansvan Straaten, Niels van Royen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography and percutaneous coronary intervention (PCI) in the treatment of patients who have been successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains uncertain. METHODS In this multicenter trial, we randomly assigned 552 patients who had cardiac arrest without signs of STEMI to undergo immediate coronary angiography or coronary angiography that was delayed until after neurologic recovery. All patients underwent PCI if indicated. The primary end point was survival at 90 days. Secondary end points included 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). The median time to target temperature was 5.4 hours in the immediate angiography group and 4.7 hours in the delayed angiography group (ratio of geometric means, 1.19; 95% CI, 1.04 to 1.36). No significant differences between the groups were found in the remaining secondary end points. CONCLUSIONS Among patients who had been successfully resuscitated after out-of-hospital cardiac arrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days.
LanguageEnglish
Pages1397-1407
JournalNew England Journal of Medicine
Volume380
Issue number15
Early online date18 Mar 2019
DOIs
Publication statusPublished - 2019

Cite this

Lemkes, Jorrit S. ; 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, R. mon ; 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. ; Oudemansvan Straaten, Heleen M. ; van Royen, Niels. / Coronary angiography after cardiac arrest without ST-segment elevation. In: New England Journal of Medicine. 2019 ; Vol. 380, No. 15. pp. 1397-1407.
@article{f8738c08a94642a6aaa27120ea87517b,
title = "Coronary angiography after cardiac arrest without ST-segment elevation",
abstract = "BACKGROUND Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography and percutaneous coronary intervention (PCI) in the treatment of patients who have been successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains uncertain. METHODS In this multicenter trial, we randomly assigned 552 patients who had cardiac arrest without signs of STEMI to undergo immediate coronary angiography or coronary angiography that was delayed until after neurologic recovery. All patients underwent PCI if indicated. The primary end point was survival at 90 days. Secondary end points included 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). The median time to target temperature was 5.4 hours in the immediate angiography group and 4.7 hours in the delayed angiography group (ratio of geometric means, 1.19; 95{\%} CI, 1.04 to 1.36). No significant differences between the groups were found in the remaining secondary end points. CONCLUSIONS Among patients who had been successfully resuscitated after out-of-hospital cardiac arrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days.",
keywords = "out-of-hospital cardiac arrest, Coronary angiography",
author = "Lemkes, {Jorrit S.} and Janssens, {Gladys N.} and {van der Hoeven}, {Nina W.} and Jewbali, {Lucia S. D.} and Dubois, {Eric A.} and Martijn Meuwissen and Rijpstra, {Tom A.} and Bosker, {Hans A.} and Blans, {Michiel J.} and Bleeker, {Gabe B.} and Baak, {R. mon} and Vlachojannis, {Georgios J.} and Eikemans, {Bob J. W.} and {van der Harst}, Pim and {van der Horst}, {Iwan C. C.} and Michiel Voskuil and {van der Heijden}, {Joris J.} and Albertus Beishuizen and Martin Stoel and Cyril Camaro and {van der Hoeven}, Hans and Henriques, {Jos{\'e} P.} and Vlaar, {Alexander P. J.} and Vink, {Maarten A.} and {van den Bogaard}, Bas and Heestermans, {Ton A. C. M.} and {de Ruijter}, Wouter and Delnoij, {Thijs S. R.} and Crijns, {Harry J. G. M.} and Jessurun, {Gillian A. J.} and Oemrawsingh, {Pranobe V.} and Gosselink, {Marcel T. M.} and Koos Plomp and Michael Magro and Elbers, {Paul W. G.} and {van de Ven}, {Peter M.} and {Oudemansvan Straaten}, {Heleen M.} and {van Royen}, Niels",
note = "Copyright {\circledC} 2019 Massachusetts Medical Society.",
year = "2019",
doi = "10.1056/NEJMoa1816897",
language = "English",
volume = "380",
pages = "1397--1407",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "15",

}

Lemkes, JS, Janssens, GN, van der Hoeven, NW, Jewbali, LSD, Dubois, EA, Meuwissen, M, Rijpstra, TA, Bosker, HA, Blans, MJ, Bleeker, GB, Baak, RM, Vlachojannis, GJ, Eikemans, BJW, van der Harst, P, van der Horst, ICC, Voskuil, M, van der Heijden, JJ, Beishuizen, A, Stoel, M, Camaro, C, van der Hoeven, H, Henriques, JP, Vlaar, APJ, Vink, MA, van den Bogaard, B, Heestermans, TACM, de Ruijter, W, Delnoij, TSR, Crijns, HJGM, Jessurun, GAJ, Oemrawsingh, PV, Gosselink, MTM, Plomp, K, Magro, M, Elbers, PWG, van de Ven, PM, Oudemansvan Straaten, HM & van Royen, N 2019, 'Coronary angiography after cardiac arrest without ST-segment elevation', New England Journal of Medicine, vol. 380, no. 15, pp. 1397-1407. https://doi.org/10.1056/NEJMoa1816897, https://doi.org/10.1056/NEJMoa1816897

Coronary angiography after cardiac arrest without ST-segment elevation. / Lemkes, Jorrit S.; 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, R. mon; 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.; Oudemansvan Straaten, Heleen M.; van Royen, Niels.

In: New England Journal of Medicine, Vol. 380, No. 15, 2019, p. 1397-1407.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Coronary angiography after cardiac arrest without ST-segment elevation

AU - Lemkes, Jorrit S.

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, R. mon

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, José 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 - Oudemansvan Straaten, Heleen M.

AU - van Royen, Niels

N1 - Copyright © 2019 Massachusetts Medical Society.

PY - 2019

Y1 - 2019

N2 - BACKGROUND Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography and percutaneous coronary intervention (PCI) in the treatment of patients who have been successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains uncertain. METHODS In this multicenter trial, we randomly assigned 552 patients who had cardiac arrest without signs of STEMI to undergo immediate coronary angiography or coronary angiography that was delayed until after neurologic recovery. All patients underwent PCI if indicated. The primary end point was survival at 90 days. Secondary end points included 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). The median time to target temperature was 5.4 hours in the immediate angiography group and 4.7 hours in the delayed angiography group (ratio of geometric means, 1.19; 95% CI, 1.04 to 1.36). No significant differences between the groups were found in the remaining secondary end points. CONCLUSIONS Among patients who had been successfully resuscitated after out-of-hospital cardiac arrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days.

AB - BACKGROUND Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography and percutaneous coronary intervention (PCI) in the treatment of patients who have been successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains uncertain. METHODS In this multicenter trial, we randomly assigned 552 patients who had cardiac arrest without signs of STEMI to undergo immediate coronary angiography or coronary angiography that was delayed until after neurologic recovery. All patients underwent PCI if indicated. The primary end point was survival at 90 days. Secondary end points included 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). The median time to target temperature was 5.4 hours in the immediate angiography group and 4.7 hours in the delayed angiography group (ratio of geometric means, 1.19; 95% CI, 1.04 to 1.36). No significant differences between the groups were found in the remaining secondary end points. CONCLUSIONS Among patients who had been successfully resuscitated after out-of-hospital cardiac arrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days.

KW - out-of-hospital cardiac arrest

KW - Coronary angiography

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85063810494&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/30883057

U2 - 10.1056/NEJMoa1816897

DO - 10.1056/NEJMoa1816897

M3 - Article

VL - 380

SP - 1397

EP - 1407

JO - New England Journal of Medicine

T2 - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 15

ER -