RCT

COACT

Coronary Angiography after Cardiac Arrest without ST-Segment Elevation

NEJM, 2019 · Multicenter randomized clinical trial in 19 centers in the Netherlands (n=552)

Clinical question

Does immediate coronary angiography improve 90-day survival compared with delayed angiography in comatose patients after OHCA without ST-segment elevation?

Population: Adults with successfully resuscitated out-of-hospital cardiac arrest, initial shockable rhythm, and no ST-segment elevation on post-ROSC ECG
Intervention: Immediate emergency coronary angiography (median time 2.3 hours)
Comparator: Delayed coronary angiography performed after neurologic recovery (median time 121.9 hours)
Primary outcome: Overall survival at 90 days
Result: 90-day survival was 64.5% in the immediate angiography group vs 67.2% in the delayed group (odds ratio 0.89; 95% CI, 0.62 to 1.27; P=0.51). Time to target temperature and ICU length of stay were similar.

What the trial found

Immediate coronary angiography provided no survival or neurological benefit over delayed angiography in post-cardiac arrest patients without ST-segment elevation.

Current guideline position

Supported in AHA and ESC 2021 post-arrest guidelines.

Clinical interpretation

Supports prioritizing ICU hemodynamic and neuroprotective stabilization over immediate emergent catheterization in non-STEMI post-arrest patients without shock.

Clinical Context & Relevant Topics (1)

Disease Reference

Cardiac Arrest & Post–Cardiac Arrest Care

Multimodal resuscitation, post-cardiac arrest syndrome management, targeted temperature control, and delayed neuroprognostication.

View Topic Context →