Abstract
Background
The clinical importance of immediate coronary angiography, with potentially subsequent
percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA)
patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility
and safety aspects of performing immediate coronary angiography in a pre-specified
pilot phase of the ‘DIrect or Subacute Coronary angiography in Out-of-hospital cardiac
arrest’ (DISCO) randomized controlled trial (ClinicalTrials.gov ID: NCT02309151).
Methods
Resuscitated bystander witnessed OHCA patients >18 years without ST-elevation on the
ECG were randomized to immediate coronary angiography versus standard of care. Event
times, procedure related adverse events and safety variables within 7 days were recorded.
Results
In total, 79 patients were randomized to immediate angiography (n = 39) or standard
of care (n = 40). No major differences in baseline characteristics between the groups
were found. There were no differences in the proportion of bleedings and renal failure.
Three patients randomized to immediate angiography and six patients randomized to
standard care died within 24 h. The median time from EMS arrival to coronary angiography
was 135 min in the immediate angiography group.
In patients randomized to immediate angiography a culprit lesion was found in 14/38
(36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized
to standard of care, coronary angiography was performed before the stipulated 3 days.
Conclusion
In this out-of-hospital cardiac arrest population without ST-elevation, randomization
to a strategy to perform immediate coronary angiography was feasible although the
time window of 120 min from EMS arrival at the scene of the arrest to start of coronary
angiography was not achieved. No significant safety issues were reported.
Keywords
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Article info
Publication history
Published online: April 24, 2019
Accepted:
April 15,
2019
Received in revised form:
April 8,
2019
Received:
January 22,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
