TY - JOUR
T1 - Effect of Timing of Coronary Angiography on Mortality After Out-of-hospital Cardiac Arrest in Elderly Patients - A Substudy of the TOMAHAWK Trial
AU - Thevathasan, Tharusan
AU - Pugachova, Svitlana
AU - Pöss, Janine
AU - Roßberg, Michelle
AU - Landmesser, Ulf
AU - Skurk, Carsten
AU - Fichtlscherer, Stephan
AU - Akin, Ibrahim
AU - Fuernau, Georg
AU - Hassager, Christian
AU - Zeymer, Uwe
AU - Preusch, Michael R
AU - Graf, Tobias
AU - Feistritzer, Hans-Josef
AU - Jobs, Alexander
AU - Schulze, P Christian
AU - de Waha, Suzanne
AU - Thiele, Holger
AU - Freund, Anne
AU - Desch, Steffen
N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2025/11/7
Y1 - 2025/11/7
N2 - BACKGROUND: The optimal timing of coronary angiography in elderly patients after out-of-hospital cardiac arrest (OHCA) without ST-segment elevations after successful resuscitation remains uncertain. This substudy of the randomized TOMAHAWK trial investigated the prognostic impact of immediate versus delayed/selective coronary angiography in elderly versus younger OHCA survivors.METHODS: A total of 529 patients with successfully resuscitated OHCA of presumed cardiac origin without ST-segment elevations on post-resuscitation electrocardiograms were analyzed. Patients had been randomized to immediate or delayed/selective coronary angiography after 24 hours the earliest. Patients were stratified by age: elderly patients defined as >75 years versus younger patients as ≤75 years. The primary endpoint was 30-day mortality. Multivariable Cox regression models were applied.RESULTS: Elderly patients exhibited a greater burden of cardiovascular comorbidities, had higher 30-day mortality (69% vs. 43%, p<0.001) and higher rates of death or severe neurologic deficit (75% vs. 51%, p<0.001) compared to younger individuals. In adjusted analyses, the timing of coronary angiography was not significantly associated with mortality in either elderly patients (HR 0.96, 95% CI, 0.59-1.56, p=0.88) or younger patients (HR 0.88, 95% CI, 0.56-1.38, p=0.57), with no evidence of effect modification by age (p for interaction=0.758).CONCLUSIONS: Routine immediate coronary angiography does not appear to modify mortality risk in both elderly and younger OHCA survivors without ST-segment elevations. The results do not support differential treatment strategies across age groups.
AB - BACKGROUND: The optimal timing of coronary angiography in elderly patients after out-of-hospital cardiac arrest (OHCA) without ST-segment elevations after successful resuscitation remains uncertain. This substudy of the randomized TOMAHAWK trial investigated the prognostic impact of immediate versus delayed/selective coronary angiography in elderly versus younger OHCA survivors.METHODS: A total of 529 patients with successfully resuscitated OHCA of presumed cardiac origin without ST-segment elevations on post-resuscitation electrocardiograms were analyzed. Patients had been randomized to immediate or delayed/selective coronary angiography after 24 hours the earliest. Patients were stratified by age: elderly patients defined as >75 years versus younger patients as ≤75 years. The primary endpoint was 30-day mortality. Multivariable Cox regression models were applied.RESULTS: Elderly patients exhibited a greater burden of cardiovascular comorbidities, had higher 30-day mortality (69% vs. 43%, p<0.001) and higher rates of death or severe neurologic deficit (75% vs. 51%, p<0.001) compared to younger individuals. In adjusted analyses, the timing of coronary angiography was not significantly associated with mortality in either elderly patients (HR 0.96, 95% CI, 0.59-1.56, p=0.88) or younger patients (HR 0.88, 95% CI, 0.56-1.38, p=0.57), with no evidence of effect modification by age (p for interaction=0.758).CONCLUSIONS: Routine immediate coronary angiography does not appear to modify mortality risk in both elderly and younger OHCA survivors without ST-segment elevations. The results do not support differential treatment strategies across age groups.
U2 - 10.1093/ehjacc/zuaf144
DO - 10.1093/ehjacc/zuaf144
M3 - Journal articles
C2 - 41206688
SN - 2048-8726
JO - European heart journal. Acute cardiovascular care
JF - European heart journal. Acute cardiovascular care
ER -
