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, 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 HeijdenAlbertus Beishuizen, Martin Stoel, Cyril Camaro, 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, Ramon B. van Loon, Niels van Royen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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 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
Original languageEnglish
JournalResuscitation
Early online date2021
DOIs
Publication statusE-pub ahead of print - 2021

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