Is immediate better than delayed angiography after cardiac arrest?

Five-year survival does not significantly differ between immediate and delayed coronary angiography in patients resuscitated from out-of-hospital cardiac arrest (OHCA) without ST-segment elevation, reports a recent study.

This trial was conducted in 19 Dutch centres and enrolled 552 OHCA patients with an initial shockable rhythm and no ST-segment elevation on initial electrocardiography after return of spontaneous circulation.  Structured telephone interviews were conducted at 5-year follow-up.

Of the patients, 514 (93.1 percent) had available data at year 5.  Among those with available data, 261 (50.8 percent) received immediate angiography, while 253 (49.2 percent) had a delayed approach. Baseline characteristics were comparable between the two treatment groups.

Five years after the index hospitalization, 143 patients (54.8 percent) in the immediate angiography group and 131 (51.8 percent) in the delayed angiography group were alive (hazard ratio [HR], 0.95, 95 percent confidence interval [CI], 0.74–1.23; p=0.072).

A nonprespecified and exploratory landmark analysis revealed a survival benefit after 90 days (HR for death to 90 days, 1.11, 95 percent CI, 0.84–1.49; p=0.46; HR for death >90 days, 0.56, 95 percent CI, 0.32–0.97; p=0.04).

Furthermore, the rates of myocardial infarction, heart failure-related hospitalization, and revascularization were low and did not significantly differ between treatment groups.

“At 5 years, survival was comparable between immediate and delayed angiography, with no clear benefit or harm,” the authors said. “A late survival benefit appeared after 90 days, though its clinical significance remains uncertain and most likely is due to chance.”