In patients resuscitated after cardiac arrest who do not show evidence of the type of heart attack known as ST-segment elevation myocardial infarction (STEMI), receiving immediate coronary angiography did not improve survival at 90 days compared to waiting a few days before undergoing the procedure, based on findings presented at the American College of Cardiology's 68th Annual Scientific Session.
Cardiac arrest is when the heart suddenly stops beating. It is most often caused by a problem with the heart's electrical system, typically the result of a heart attack. According to the Centers for Disease Control and Prevention, about 350,000 people experience cardiac arrest outside of a hospital setting in the U.S. annually, and more than 70 percent of them die.
For people who are resuscitated from cardiac arrest due to STEMI, the most severe type of heart attack, it is common practice to immediately proceed with coronary angiography, a procedure performed in a cardiac catheterization laboratory, that offers doctors a view of the condition of the heart's arteries. If blockages are found, the medical team then clears them by inserting a stent in the arteries through a thin tube threaded through an artery, a procedure called percutaneous coronary intervention (PCI). However, it has been unclear whether this practice is beneficial for people who suffer cardiac arrest without STEMI. This study is the first randomized controlled trial to shed light on the optimal timing of coronary angiography in these patients.
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"It is an important trial for the entire cardiac arrest team," said Jorrit Lemkes, MD, a cardiologist at Amsterdam University Medical Centre in the Netherlands and the study's lead author. "The question of whether or not to immediately send the patient for catheterization comes up routinely in this group of patients. This trial gives us more information on that question, suggesting patients who do not show ST-segment elevation on the electrocardiogram do not require an immediate invasive strategy after cardiac arrest."
The trial enrolled 552 patients who were treated at 19 medical centers in the Netherlands after suffering cardiac arrest outside of a hospital. All patients were evaluated with an electrocardiogram upon arrival at the emergency department and found not to have evidence of STEMI. Half of the patients were randomly assigned to immediately proceed to the cardiac catheterization laboratory, where they underwent coronary angiography and subsequent PCI if needed. The other half were transferred to the intensive care unit for standard post-resuscitation care. These patients underwent coronary angiography and PCI, if needed, only after they awoke and showed signs of neurological recovery, which typically occurs after a few days.