Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation

Desch, Steffen; Freund, Anne; Akın, İbrahim; Behnes, Michael; Preusch, Michael; Zelniker, Thomas A; Skurk, Carsten; Landmesser, Ulf; Graf, Tobias; Eitel, Ingo; Fuernau, Georg; Haake, Hendrik; Nordbeck, Peter; Hammer, Fabian; Felix, Stephan B.; Hassager, Christian; Engstrøm, Thomas; Fichtlscherer, Stephan; Ledwoch, Jakob; Lenk, Karsten; Joner, Michael; Steiner, Stephan; Liebetrau, Christoph; Voigt, Ingo; Zeymer, Uwe; Brand, Michael; Schmitz, Roland; Horstkotte, Jan; Jacobshagen, Claudius; Pöss, Janine; Abdel‐Wahab, Mohamed; Lurz, Philipp; Jobs, Alexander; Waha‐Thiele, Suzanne de; Olbrich, Denise; Sandig, Frank; König, Inke R.; Brett, Sabine; Vens, Maren; Klinge, Kathrin; Thiele, Holger; Investigators, Tomahawk

doi:10.1056/nejmoa2101909

Cited by 241 publications

(175 citation statements)

References 25 publications

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“…Collectively, these results imply that revascularization with PCI drives the benefit of early CAG. Yet, they run contrary to the randomized controlled COACT, PEARL, and TOMAHAWK trials [ 10 , 12 , 14 ], which may be explained by the following: (1) We included all resuscitated OHCA patients of presumed cardiac etiology, regardless of ECG findings. It is conceivable that a significant proportion of the benefits of early CAG and revascularization seen in our study were driven by those with STEMI.…”

Section: Discussionmentioning

confidence: 99%

“…These studies are limited by selection bias—patients selected for CAG usually have more favorable characteristics and receive more aggressive overall care, which partly accounts for the association with better outcomes. In contrast, the randomized controlled Coronary Angiography after Cardiac Arrest (COACT) trial, Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation (PEARL) study, Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest (DISCO) pilot study, Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) trial, and a recent systematic review failed to show the superiority of early CAG to delayed CAG in improving survival of resuscitated OHCA patients without ST-segment elevation (STE) [ 10 , 11 , 12 , 13 , 14 ]. Current guidelines recommend emergent CAG in OHCA subjects with STE on post-resuscitation ECG, suspected acute myocardial infarction, or evidence of hemodynamic or electrical instability [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Early Coronary Angiography Is Associated with Improved 30-Day Outcomes among Patients with Out-of-Hospital Cardiac Arrest

Lim

Lau

Chan

et al. 2021

JCM

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We evaluated the association between early coronary angiography (CAG) and outcomes in resuscitated out-of-hospital cardiac arrest (OHCA) patients, by linking data from the Singapore Pan-Asian Resuscitation Outcomes Study, with a national registry of cardiac procedures. The 30-day survival and neurological outcome were compared between patients undergoing early CAG (within 1-calender day), versus patients not undergoing early CAG. Inverse probability weighted estimates (IPWE) adjusted for non-randomized CAG. Of 976 resuscitated OHCA patients of cardiac etiology between 2011–2015 (mean(SD) age 64(13) years, 73.7% males), 337 (34.5%) underwent early CAG, of whom, 230 (68.2%) underwent PCI. Those who underwent early CAG were significantly younger (60(12) vs. 66(14) years old), healthier (42% vs. 59% with heart disease; 29% vs. 44% with diabetes), more likely males (86% vs. 67%), and presented with shockable rhythms (69% vs. 36%), compared with those who did not. Early CAG with PCI was associated with better survival and neurological outcome (adjusted odds ratio 1.91 and 1.82 respectively), findings robust to IPWE adjustment. The rates of bleeding and stroke were similar. CAG with PCI within 24 h was associated with improved clinical outcomes after OHCA, without increasing complications. Further studies are required to identify the characteristics of patients who would benefit most from this invasive strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early Coronary Angiography Is Associated with Improved 30-Day Outcomes among Patients with Out-of-Hospital Cardiac Arrest

Lim

Lau

Chan

et al. 2021

JCM

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“…Although selecting OHCA survivors without STE who will have good neurologic outcomes is important, the next step will be to identify which OHCA survivors have a significant coronary occlusion. Comparing immediate and delayed CAG in cardiac arrest patients with STE, recent randomized controlled trials, such as Coronary Angiography after Cardiac Arrest (COACT) and Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK), and a systematic review failed to show the superiority of immediate CAG over delayed CAG in improving the survival of resuscitated OHCA patients without STE [ 40 , 41 ]. Thus, the aim of our study was to develop an ML-based model for the early (within 24 h) identification of patients with a significant coronary artery lesion.…”

Section: Discussionmentioning

confidence: 99%

Early Identification of Resuscitated Patients with a Significant Coronary Disease in Out-of-Hospital Cardiac Arrest Survivors without ST-Segment Elevation

Youn

Song

et al. 2021

JCM

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This study aimed to develop a machine learning (ML)-based model for identifying patients who had a significant coronary artery disease among out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE). This multicenter observational study used data from the Korean Hypothermia Network prospective registry (KORHN-PRO) gathered between October 2015 and December 2018. We used information available before targeted temperature management (TTM) as predictor variables, and the primary outcome was a significant coronary artery lesion in coronary angiography (CAG). Among 1373 OHCA patients treated with TTM, 331 patients without STE who underwent CAG were enrolled. Among them, 127 patients (38.4%) had a significant coronary artery lesion. Four ML algorithms, namely regularized logistic regression (RLR), random forest classifier (RF), CatBoost classifier (CBC), and voting classifier (VC), were used with data collected before CAG. The VC model showed the highest accuracy for predicting significant lesions (area under the curve of 0.751). Eight variables (older age, male, initial shockable rhythm, shorter total collapse duration, higher glucose and creatinine, and lower pH and lactate) were significant to ML models. These results showed that ML models may be useful in developing early predictive tools for identifying high-risk patients with a significant stenosis in CAG.

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“…Speaking of blue-light ambulances, should they be going to A&E or straight to the catheter laboratory after an out-of-hospital cardiac arrest? A multicentre, open-label, randomised trial enrolled 554 patients who had an out-of-hospital cardiac arrest without ST segment elevation to either immediate angiography or initial intensive care assessment (then delayed or selected angiography) 1. It found no statistically significant difference in death at 30 days, with 54% dying in the immediate angiography group and 46% in the delayed angiography group.…”

Section: Compression Chambermentioning

confidence: 99%

Tom Nolan's research reviews—13 January 2022

Nolan¹

2022

BMJ

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Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation

Cited by 241 publications

References 25 publications

Early Coronary Angiography Is Associated with Improved 30-Day Outcomes among Patients with Out-of-Hospital Cardiac Arrest

Early Coronary Angiography Is Associated with Improved 30-Day Outcomes among Patients with Out-of-Hospital Cardiac Arrest

Early Identification of Resuscitated Patients with a Significant Coronary Disease in Out-of-Hospital Cardiac Arrest Survivors without ST-Segment Elevation

Tom Nolan's research reviews—13 January 2022

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