Jorrit S Lemkes1, Gladys N Janssens1, Nina W van der Hoeven1, Lucia S D Jewbali2, Eric A Dubois2, Martijn M Meuwissen3, Topm A Rijpstra4, Hans A Bosker5, Michiel J Blans6, Gabe B Bleeker7, Remon R Baak8, George J Vlachojannis9, Bob J W Eikemans10, Pim van der Harst11,12, Iwan C C van der Horst13,14, Michiel Voskuil13, Joris J van der Heijden15, Albertus Beishuizen16, Martin Stoel17, Cyril Camaro18, Hans van der Hoeven19, Jose P Henriques20, Alexander P J Vlaar21, Maarten A Vink22, Bas van den Bogaard23, Ton A C M Heestermans24, Wouter de Ruijter25, Thijs S R Delnoij14, Harry J G M Crijns26, Gillian A J Jessurun27, Pranobe V Oemrawsingh28, Marcel T M Gosselink29, Koos Plomp30, Michael Magro31, Paul W G Elbers32, Eva M Spoormans1, Peter M van de Ven33, Heleen M Oudemans-van Straaten32, Niels van Royen1,18. 1. Department of Cardiology, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands. 2. Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands. 3. Department of Cardiology, Amphia Hospital, Breda, the Netherlands. 4. Department of Intensive Care Medicine, Amphia Hospital, Breda, the Netherlands. 5. Department of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands. 6. Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, the Netherlands. 7. Department of Cardiology, HAGA Hospital, Den Haag, the Netherlands. 8. Department of Intensive care medicine, HAGA Hospital, Den Haag, the Netherlands. 9. Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands. 10. Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands. 11. Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 12. Department of Intensive Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 13. Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands. 14. Department of Intensive Care Medicine, Maastricht University Medical Center, University Maastricht, Maastricht, the Netherlands. 15. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. 16. Department of Intensive Care Medicine, Medisch Spectrum Twente, Enschede, the Netherlands. 17. Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands. 18. Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands. 19. Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands. 20. Department of Cardiology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands. 21. Department of Intensive Care Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands. 22. Department of Cardiology, OLVG, Amsterdam, the Netherlands. 23. Department of Intensive Care Medicine, OLVG, Amsterdam, the Netherlands. 24. Department of Cardiology, Noord West Ziekenhuisgroep, Alkmaar, the Netherlands. 25. Department of Intensive Care Medicine, Noord West Ziekenhuisgroep, Alkmaar, the Netherlands. 26. Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands. 27. Department of Cardiology, Scheper Hospital, Emmen, the Netherlands. 28. Department of Cardiology, Haaglanden Medical Center, Den Haag, the Netherlands. 29. Department of Cardiology, Isala Hospital, Zwolle, the Netherlands. 30. Department of Cardiology, Ter Gooi Hospital, Blaricum, the Netherlands. 31. Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands. 32. Department of Intensive Care Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands. 33. Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands.
Abstract
Importance: Ischemic heart disease is a common cause of cardiac arrest. However, randomized data on long-term clinical outcomes of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients successfully resuscitated from cardiac arrest in the absence of ST segment elevation myocardial infarction (STEMI) are lacking. Objective: To determine whether immediate coronary angiography improves clinical outcomes at 1 year in patients after cardiac arrest without signs of STEMI, compared with a delayed coronary angiography strategy. Design, Setting, and Participants: A prespecified analysis of a multicenter, open-label, randomized clinical trial evaluated 552 patients who were enrolled in 19 Dutch centers between January 8, 2015, and July 17, 2018. The study included patients who experienced out-of-hospital cardiac arrest with a shockable rhythm who were successfully resuscitated without signs of STEMI. Follow-up was performed at 1 year. Data were analyzed, using the intention-to-treat principle, between August 29 and October 10, 2019. Interventions: Immediate coronary angiography and PCI if indicated or coronary angiography and PCI if indicated, delayed until after neurologic recovery. Main Outcomes and Measures: Survival, myocardial infarction, revascularization, implantable cardiac defibrillator shock, quality of life, hospitalization for heart failure, and the composite of death or myocardial infarction or revascularization after 1 year. Results: At 1 year, data on 522 of 552 patients (94.6%) were available for analysis. Of these patients, 413 were men (79.1%); mean (SD) age was 65.4 (12.3) years. A total of 162 of 264 patients (61.4%) in the immediate angiography group and 165 of 258 patients (64.0%) in the delayed angiography group were alive (odds ratio, 0.90; 95% CI, 0.63-1.28). The composite end point of death, myocardial infarction, or repeated revascularization since the index hospitalization was met in 112 patients (42.9%) in the immediate group and 104 patients (40.6%) in the delayed group (odds ratio, 1.10; 95% CI, 0.77-1.56). No significant differences between the groups were observed for the other outcomes at 1-year follow-up. For example, the rate of ICD shocks was 20.4% in the immediate group and 16.2% in the delayed group (odds ratio, 1.32; 95% CI, 0.66-2.64). Conclusions and Relevance: In this trial of patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, a strategy of immediate angiography was not found to be superior to a strategy of delayed angiography with respect to clinical outcomes at 1 year. Coronary angiography in this patient group can therefore be delayed until after neurologic recovery without affecting outcomes. Trial Registration: trialregister.nl Identifier: NTR4973.
Importance: Ischemic heart disease is a common cause of cardiac arrest. However, randomized data on long-term clinical outcomes of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients successfully resuscitated from cardiac arrest in the absence of ST segment elevation myocardial infarction (STEMI) are lacking. Objective: To determine whether immediate coronary angiography improves clinical outcomes at 1 year in patients after cardiac arrest without signs of STEMI, compared with a delayed coronary angiography strategy. Design, Setting, and Participants: A prespecified analysis of a multicenter, open-label, randomized clinical trial evaluated 552 patients who were enrolled in 19 Dutch centers between January 8, 2015, and July 17, 2018. The study included patients who experienced out-of-hospital cardiac arrest with a shockable rhythm who were successfully resuscitated without signs of STEMI. Follow-up was performed at 1 year. Data were analyzed, using the intention-to-treat principle, between August 29 and October 10, 2019. Interventions: Immediate coronary angiography and PCI if indicated or coronary angiography and PCI if indicated, delayed until after neurologic recovery. Main Outcomes and Measures: Survival, myocardial infarction, revascularization, implantable cardiac defibrillator shock, quality of life, hospitalization for heart failure, and the composite of death or myocardial infarction or revascularization after 1 year. Results: At 1 year, data on 522 of 552 patients (94.6%) were available for analysis. Of these patients, 413 were men (79.1%); mean (SD) age was 65.4 (12.3) years. A total of 162 of 264 patients (61.4%) in the immediate angiography group and 165 of 258 patients (64.0%) in the delayed angiography group were alive (odds ratio, 0.90; 95% CI, 0.63-1.28). The composite end point of death, myocardial infarction, or repeated revascularization since the index hospitalization was met in 112 patients (42.9%) in the immediate group and 104 patients (40.6%) in the delayed group (odds ratio, 1.10; 95% CI, 0.77-1.56). No significant differences between the groups were observed for the other outcomes at 1-year follow-up. For example, the rate of ICD shocks was 20.4% in the immediate group and 16.2% in the delayed group (odds ratio, 1.32; 95% CI, 0.66-2.64). Conclusions and Relevance: In this trial of patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, a strategy of immediate angiography was not found to be superior to a strategy of delayed angiography with respect to clinical outcomes at 1 year. Coronary angiography in this patient group can therefore be delayed until after neurologic recovery without affecting outcomes. Trial Registration: trialregister.nl Identifier: NTR4973.
Authors: Jordi Sans Roselló; Maria Vidal-Burdeus; Pablo Loma-Osorio; Alexandra Pons Riverola; Gil Bonet Pineda; Nabil El Ouaddi; Jaime Aboal; Albert Ariza Solé; Claudia Scardino; Cosme García-García; Estefanía Fernández-Peregrina; Alessandro Sionis Journal: Int J Cardiol Heart Vasc Date: 2022-04-27
Authors: Cyril Camaro; Judith L Bonnes; Eddy M Adang; Eva M Spoormans; Gladys N Janssens; Nina W van der Hoeven; Lucia S Jewbali; Eric A Dubois; Martijn Meuwissen; Tom A Rijpstra; Hans A Bosker; Michiel J Blans; Gabe B Bleeker; Rémon Baak; George J Vlachojannis; Bob J Eikemans; Pim van der Harst; Iwan C van der Horst; Michiel Voskuil; Joris J van der Heijden; Bert Beishuizen; Martin Stoel; Hans van der Hoeven; José P Henriques; Alexander P Vlaar; Maarten A Vink; Bas van den Bogaard; Ton A Heestermans; Wouter de Ruijter; Thijs S Delnoij; Harry J Crijns; Gillian A Jessurun; Pranobe V Oemrawsingh; Marcel T Gosselink; Koos Plomp; Michael Magro; Paul W Elbers; Peter M van de Ven; Jorrit S Lemkes; Niels van Royen Journal: J Am Heart Assoc Date: 2022-02-23 Impact factor: 6.106
Authors: Eva M Spoormans; Jorrit S Lemkes; Gladys N Janssens; Ouissal Soultana; Nina W van der Hoeven; Lucia S D Jewbali; Eric A Dubois; Martijn Meuwissen; Tom A Rijpstra; Hans A Bosker; Michiel J Blans; Gabe B Bleeker; Remon Baak; Georgios J Vlachojannis; Bob J W Eikemans; Pim van der Harst; Iwan C C van der Horst; Michiel Voskuil; Joris J van der Heijden; Albertus Beishuizen; Martin Stoel; Cyril Camaro; Hans van der Hoeven; José P Henriques; Alexander P J Vlaar; Maarten A Vink; Bas van den Bogaard; Ton A C M Heestermans; Wouter de Ruijter; Thijs S R Delnoij; Harry J G M Crijns; Pranobe V Oemrawsingh; Marcel T M Gosselink; Koos Plomp; Michael Magro; Paul W G Elbers; Peter M van de Ven; Niels van Royen Journal: Eur Heart J Acute Cardiovasc Care Date: 2022-07-21