TY - JOUR
T1 - Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation
AU - TOMAHAWK Investigators
AU - Desch, Steffen
AU - Freund, Anne
AU - Akin, Ibrahim
AU - Behnes, Michael
AU - Preusch, Michael R
AU - Zelniker, Thomas A
AU - Skurk, Carsten
AU - Landmesser, Ulf
AU - Graf, Tobias
AU - Eitel, Ingo
AU - Fuernau, Georg
AU - Haake, Hendrik
AU - Nordbeck, Peter
AU - Hammer, Fabian
AU - Felix, Stephan B
AU - Hassager, Christian
AU - Engstrøm, Thomas
AU - Fichtlscherer, Stephan
AU - Ledwoch, Jakob
AU - Lenk, Karsten
AU - Joner, Michael
AU - Steiner, Stephan
AU - Liebetrau, Christoph
AU - Voigt, Ingo
AU - Zeymer, Uwe
AU - Brand, Michael
AU - Schmitz, Roland
AU - Horstkotte, Jan
AU - Jacobshagen, Claudius
AU - Pöss, Janine
AU - Abdel-Wahab, Mohamed
AU - Lurz, Philipp
AU - Jobs, Alexander
AU - de Waha-Thiele, Suzanne
AU - Olbrich, Denise
AU - Sandig, Frank
AU - König, Inke R
AU - Brett, Sabine
AU - Vens, Maren
AU - Klinge, Kathrin
AU - Thiele, Holger
N1 - Copyright © 2021 Massachusetts Medical Society.
PY - 2021/12/30
Y1 - 2021/12/30
N2 - BACKGROUND: Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest. However, the benefits of early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST-segment elevation are unclear.METHODS: In this multicenter trial, we randomly assigned 554 patients with successfully resuscitated out-of-hospital cardiac arrest of possible coronary origin to undergo either immediate coronary angiography (immediate-angiography group) or initial intensive care assessment with delayed or selective angiography (delayed-angiography group). All the patients had no evidence of ST-segment elevation on postresuscitation electrocardiography. The primary end point was death from any cause at 30 days. Secondary end points included a composite of death from any cause or severe neurologic deficit at 30 days.RESULTS: A total of 530 of 554 patients (95.7%) were included in the primary analysis. At 30 days, 143 of 265 patients (54.0%) in the immediate-angiography group and 122 of 265 patients (46.0%) in the delayed-angiography group had died (hazard ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.63; P = 0.06). The composite of death or severe neurologic deficit occurred more frequently in the immediate-angiography group (in 164 of 255 patients [64.3%]) than in the delayed-angiography group (in 138 of 248 patients [55.6%]), for a relative risk of 1.16 (95% CI, 1.00 to 1.34). Values for peak troponin release and for the incidence of moderate or severe bleeding, stroke, and renal-replacement therapy were similar in the two groups.CONCLUSIONS: Among patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation, a strategy of performing immediate angiography provided no benefit over a delayed or selective strategy with respect to the 30-day risk of death from any cause. (Funded by the German Center for Cardiovascular Research; TOMAHAWK ClinicalTrials.gov number, NCT02750462.).
AB - BACKGROUND: Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest. However, the benefits of early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST-segment elevation are unclear.METHODS: In this multicenter trial, we randomly assigned 554 patients with successfully resuscitated out-of-hospital cardiac arrest of possible coronary origin to undergo either immediate coronary angiography (immediate-angiography group) or initial intensive care assessment with delayed or selective angiography (delayed-angiography group). All the patients had no evidence of ST-segment elevation on postresuscitation electrocardiography. The primary end point was death from any cause at 30 days. Secondary end points included a composite of death from any cause or severe neurologic deficit at 30 days.RESULTS: A total of 530 of 554 patients (95.7%) were included in the primary analysis. At 30 days, 143 of 265 patients (54.0%) in the immediate-angiography group and 122 of 265 patients (46.0%) in the delayed-angiography group had died (hazard ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.63; P = 0.06). The composite of death or severe neurologic deficit occurred more frequently in the immediate-angiography group (in 164 of 255 patients [64.3%]) than in the delayed-angiography group (in 138 of 248 patients [55.6%]), for a relative risk of 1.16 (95% CI, 1.00 to 1.34). Values for peak troponin release and for the incidence of moderate or severe bleeding, stroke, and renal-replacement therapy were similar in the two groups.CONCLUSIONS: Among patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation, a strategy of performing immediate angiography provided no benefit over a delayed or selective strategy with respect to the 30-day risk of death from any cause. (Funded by the German Center for Cardiovascular Research; TOMAHAWK ClinicalTrials.gov number, NCT02750462.).
U2 - 10.1056/NEJMoa2101909
DO - 10.1056/NEJMoa2101909
M3 - Journal articles
C2 - 34459570
SN - 0028-4793
VL - 385
SP - 2544
EP - 2553
JO - The New England journal of medicine
JF - The New England journal of medicine
IS - 27
ER -
