In cardiac arrest without STEMI, timing of angiography does not impact 1-year outcomes
PHILADELPHIA — Immediate coronary angiography and delayed coronary angiography conferred similar outcomes at 1 year in patients resuscitated from cardiac arrest but without STEMI, according to new data from the COACT trial presented at the American Heart Association Scientific Sessions.
As Healio previously reported, at 90 days, among patients revived from out-of-hospital cardiac arrest who had ischemic heart disease but not STEMI, there was no difference in survival or myocardial injury between immediate and delayed angiography. Jorrit S. Lemkes, MD, interventional cardiologist at Amsterdam University Medical Center, presented the 1-year findings here.
Although there were no differences in the 90-day results, “observational studies favor early angiography on long-term mortality,” so 1-year follow-up was planned, Lemkes said during a presentation.
At 1 year, survival rates were 61.4% in the immediate angiography group and 64% in the delayed angiography group (OR = 0.9; 95% CI, 0.63-1.28; HR based on Kaplan-Meier estimate = 1.09; 95% CI, 0.83-1.45; HR based on landmark analysis between 90 and 365 days = 0.85; 95% CI, 0.26-2.78), he said.
The researchers also found no significant differences between the groups in the following outcomes:
- MI since index hospitalization: immediate group, 0.8%; delayed group, 0.4%; OR = 1.96; 95% CI, 0.18-21.8;
- any revascularization since index hospitalization: immediate group, 3.8%; delayed group, 3.9%; OR = 0.98; 95% CI, 0.4-2.39;
- any PCI since index hospitalization: immediate group, 3%; delayed group, 3.1%; OR = 0.98; 95% CI, 0.36-2.64;
- any CABG since index hospitalization: immediate group, 0.8%; delayed group, 0.8%; OR = 0.98; 95% CI, 0.14-6.99;
- HF hospitalization since index hospitalization: immediate group, 0.8%; delayed group, 0.4%; OR = 1.96; 95% CI, 0.18-21.8; and
- implantable cardioverter defibrillator shocks: immediate group, 20.4%; delayed group, 16.2%; OR = 1.32; 95% CI, 0.66-2.64.
Quality of life outcomes at 1 year were also similar between the groups, Lemkes said, noting the median Rand-36 physical component summary score was 49.2 in the immediate group and 50.4 in the delayed group, whereas the median Rand-36 mental component summary score was 51.3 in the immediate group and 50 in the delayed group.
The 552 patients from 19 centers in the Netherlands were comatose (Glasgow coma score < 8) after resuscitation for out-of-hospital cardiac arrest, had ventricular fibrillation or ventricular tachycardia as their initial arrest rhythm and did not have STEMI, acute intracranial bleeding or stroke or a noncoronary cause of arrest.
At 1 year, 264 patients in the immediate group (mean age, 66 years; 81% men) and 258 patients in the delayed group (mean age, 65 years; 77% men) were available for follow-up. By 1 year, coronary angiography had been performed in 97% of the immediate group and 64.7% of the delayed group, Lemkes said.
“In patients with restored spontaneous circulation after out-of-hospital cardiac arrest without signs of STEMI, immediate coronary angiography was not found to improve survival at 1 year compared to a delayed invasive strategy,” he said during the presentation. “There was also no difference in the rate of myocardial infarction, revascularization, hospitalization due to heart failure or ICD shocks between the two groups at 1 year.” – by Erik Swain
Lemkes JS, et al. Late Breaking Science IV: State of the Art Interventional Management for ACS Patients. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Disclosure: The study was supported by unrestricted research grants from AstraZeneca, Biotronik and the Netherlands Heart Institute. Lemkes reports no relevant financial disclosures.