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

被引：268

作者：

Desch, Steffen ^{[1
,3
,5
,8
]}

Freund, Anne ^{[1
,3
,8
]}

Akin, Ibrahim ^{[8
,10
]}

Behnes, Michael ^{[8
,10
]}

Preusch, Michael R. ^{[8
,11
]}

Zelniker, Thomas A. ^{[8
,11
,28
]}

Skurk, Carsten ^{[8
,9
]}

Landmesser, Ulf ^{[8
,9
]}

Graf, Tobias ^{[5
,8
]}

Eitel, Ingo ^{[5
,8
]}

Fuernau, Georg ^{[5
,8
]}

Haake, Hendrik ^{[12
]}

Nordbeck, Peter ^{[13
]}

Hammer, Fabian ^{[8
,14
]}

Felix, Stephan B. ^{[8
,14
]}

Hassager, Christian ^{[29
,30
]}

Engstrom, Thomas ^{[29
,30
]}

Fichtlscherer, Stephan ^{[7
]}

Ledwoch, Jakob ^{[8
,16
]}

Lenk, Karsten ^{[4
]}

Joner, Michael ^{[8
,17
]}

Steiner, Stephan ^{[18
]}

Liebetrau, Christoph ^{[8
,19
]}

Voigt, Ingo ^{[20
,21
]}

Zeymer, Uwe ^{[22
]}

Brand, Michael ^{[23
]}

Schmitz, Roland ^{[24
]}

Horstkotte, Jan ^{[25
]}

Jacobshagen, Claudius ^{[8
,26
,27
]}

Poss, Janine ^{[1
]}

Abdel-Wahab, Mohamed ^{[1
]}

Lurz, Philipp ^{[1
]}

Jobs, Alexander ^{[1
,3
,5
,8
]}

de Waha-Thiele, Suzanne ^{[2
]}

Olbrich, Denise ^{[6
,8
]}

Sandig, Frank ^{[8
,15
]}

Koenig, Inke R. ^{[7
,8
]}

Brett, Sabine ^{[6
,8
]}

Vens, Maren ^{[7
,8
]}

Klinge, Kathrin ^{[6
,8
]}

Thiele, Holger ^{[1
,3
]}

机构：

[1] Univ Leipzig, Heart Ctr Leipzig, Dept Internal Med Cardiol, Strumpellstr 39, D-04289 Leipzig, Germany

[2] Leipzig Heart Inst, Dept Cardiac Surg, Leipzig, Germany

[3] Leipzig Heart Inst, Leipzig, Germany

[4] Univ Clin Leipzig, Leipzig, Germany

[5] Univ Heart Ctr Lubeck, Lubeck, Germany

[6] Ctr Clin Trials, Lubeck, Germany

[7] Univ Lubeck, Inst Med Biometry & Stat, Lubeck, Germany

[8] German Ctr Cardiovasc Res, Berlin, Germany

[9] Univ Clin Charite, Campus Benjamin Franklin, Berlin, Germany

[10] Univ Clin Mannheim, Mannheim, Germany

[11] Univ Hosp Heidelberg, Dept Cardiol Angiol & Pneumol, Heidelberg, Germany

[12] Kliniken Maria Hilf, Monchengladbach, Germany

[13] Univ Clin Wurzburg, Wurzburg, Germany

[14] Univ Clin Greifswald, Greifswald, Germany

[15] Univ Clin Frankfurt, Frankfurt, Germany

[16] Tech Univ, Rechts Isar Hosp, Munich, Germany

[17] German Heart Ctr, Dept Cardiol, Munich, Germany

[18] St Vincenz Hosp, Dept Cardiol Pneumol & Intensive Care, Limburg, Germany

[19] Kerckhoff Clin, Bad Nauheim, Germany

[20] Elisabeth Hosp Essen, Dept Acute & Emergency Med, Essen, Germany

[21] Elisabeth Hosp Essen, Dept Cardiol & Angiol, Essen, Germany

[22] Klinikum Ludwigshafen, Ludwigshafen, Germany

[23] Klinikum Ruhr Univ Bochum, Marien Hosp Herne, Univ Clin, Herne, Germany

[24] Univ Heart Ctr, Bad Krozingen, Germany

[25] Diakonissenkrankenhaus Flensburg, Flensburg, Germany

[26] Univ Med Gottingen, Gottingen, Germany

[27] Vincentius Diakonissen Hosp, Karlsruhe, Germany

[28] Med Univ Vienna, Div Cardiol, Vienna, Austria

[29] Univ Copenhagen, Rigshosp, Dept Cardiol, Copenhagen, Denmark

[30] Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2021年 / 385卷 / 27期

关键词：

ACUTE MYOCARDIAL-INFARCTION; PERCUTANEOUS CORONARY INTERVENTION; INSIGHTS; SURVIVORS; DESIGN; ELECTROCARDIOGRAM; RATIONALE; DIAGNOSIS; TROPONIN;

D O I：

10.1056/NEJMoa2101909

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest. However, the benefits of early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST-segment elevation are unclear. Methods In this multicenter trial, we randomly assigned 554 patients with successfully resuscitated out-of-hospital cardiac arrest of possible coronary origin to undergo either immediate coronary angiography (immediate-angiography group) or initial intensive care assessment with delayed or selective angiography (delayed-angiography group). All the patients had no evidence of ST-segment elevation on postresuscitation electrocardiography. The primary end point was death from any cause at 30 days. Secondary end points included a composite of death from any cause or severe neurologic deficit at 30 days. Results A total of 530 of 554 patients (95.7%) were included in the primary analysis. At 30 days, 143 of 265 patients (54.0%) in the immediate-angiography group and 122 of 265 patients (46.0%) in the delayed-angiography group had died (hazard ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.63; P=0.06). The composite of death or severe neurologic deficit occurred more frequently in the immediate-angiography group (in 164 of 255 patients [64.3%]) than in the delayed-angiography group (in 138 of 248 patients [55.6%]), for a relative risk of 1.16 (95% CI, 1.00 to 1.34). Values for peak troponin release and for the incidence of moderate or severe bleeding, stroke, and renal-replacement therapy were similar in the two groups. Conclusions Among patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation, a strategy of performing immediate angiography provided no benefit over a delayed or selective strategy with respect to the 30-day risk of death from any cause.

引用

页码：2544 / 2553

页数：10

共 25 条

[11]

JENNETT B, 1975, LANCET, V1, P480

[12] Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials [J].

Jobs, Alexander ;

Mehta, Shamir R. ;

Montalescot, Gilles ;

Vicaut, Eric ;

van't Hof, Arnoud W. J. ;

Badings, Erik A. ;

Neumann, Franz-Josef ;

Kastrati, Adnan ;

Sciahbasi, Alessandro ;

Reuter, Paul-Georges ;

Lapostolle, Frederic ;

Milosevic, Aleksandra ;

Stankovic, Goran ;

Milasinovic, Dejan ;

Vonthein, Reinhard ;

Desch, Steffen ;

Thiele, Holger .

LANCET, 2017, 390 (10096) :737-746

[13] Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation The PEARL Study [J].

Kern, Karl B. ;

Radsel, Peter ;

Jentzer, Jacob C. ;

Seder, David B. ;

Lee, Kwan S. ;

Lotun, Kapildeo ;

Janardhanan, Rajesh ;

Stub, Dion ;

Hsu, Chiu-Hsieh ;

Noc, Marko .

CIRCULATION, 2020, 142 (21) :2002-2012

[14] Design of DISCO-Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest study [J].

Lagedal, Rickard ;

Elfwen, Ludvig ;

James, Stefan ;

Oldgren, Jonas ;

Erlinge, David ;

Ostlund, Ollie ;

Wallin, Ewa ;

Larsson, Ing-Marie ;

Lilja, Gisela ;

Cronberg, Tobias ;

Rubertsson, Sten ;

Nordberg, Per .

AMERICAN HEART JOURNAL, 2018, 197 :53-61

[15]

Lee SE, 2015, YONSEI MED J, V56, P887

[16] A NEW SIMPLIFIED ACUTE PHYSIOLOGY SCORE (SAPS-II) BASED ON A EUROPEAN NORTH-AMERICAN MULTICENTER STUDY [J].

LEGALL, JR ;

LEMESHOW, S ;

SAULNIER, F .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 270 (24) :2957-2963

[17] Coronary Angiography After Cardiac Arrest Without ST Segment Elevation: One-Year Outcomes of the COACT Randomized Clinical Trial [J].

Lemkes, Jorrit S. ;

Janssens, Gladys N. ;

van der Hoeven, Nina W. ;

Jewbali, Lucia S. D. ;

Dubois, Eric A. ;

Meuwissen, Martijn M. ;

Rijpstra, Topm A. ;

Bosker, Hans A. ;

Blans, Michiel J. ;

Bleeker, Gabe B. ;

Baak, Remon R. ;

Vlachojannis, George J. ;

Eikemans, Bob J. W. ;

van der Harst, Pim ;

van der Horst, Iwan C. C. ;

Voskuil, Michiel ;

van der Heijden, Joris J. ;

Beishuizen, Albertus ;

Stoel, Martin ;

Camaro, Cyril ;

van der Hoeven, Hans ;

Henriques, Jose P. ;

Vlaar, Alexander P. J. ;

Vink, Maarten A. ;

van den Bogaard, Bas ;

Heestermans, Ton A. C. M. ;

de Ruijter, Wouter ;

Delnoij, Thijs S. R. ;

Crijns, Harry J. G. M. ;

Jessurun, Gillian A. J. ;

Oemrawsingh, Pranobe V. ;

Gosselink, Marcel T. M. ;

Plomp, Koos ;

Magro, Michael ;

Elbers, Paul W. G. ;

Spoormans, Eva M. ;

van de Ven, Peter M. ;

Oudemans-van Straaten, Heleen M. ;

van Royen, Niels .

JAMA CARDIOLOGY, 2020, 5 (12) :1358-1365

[18] Coronary Angiography after Cardiac Arrest without ST-Segment Elevation [J].

Lemkes, Jorrit S. ;

Janssens, Gladys N. ;

van der Hoeven, Nina W. ;

Jewbali, Lucia S. D. ;

Dubois, Eric A. ;

Meuwissen, Martijn ;

Rijpstra, Tom A. ;

Bosker, Hans A. ;

Blans, Michiel J. ;

Bleeker, Gabe B. ;

Baak, Remon ;

Vlachojannis, Georgios J. ;

Eikemans, Bob J. W. ;

van der Harst, Pim ;

van der Horst, Iwan C. C. ;

Voskuil, Michiel ;

van der Heijden, Joris J. ;

Beishuizen, Albertus ;

Stoel, Martin ;

Camaro, Cyril ;

van der Hoeven, Hans ;

Henriques, Jose P. ;

Vlaar, Alexander P. J. ;

Vink, Maarten A. ;

van den Bogaard, Bas ;

Heestermans, Ton A. C. M. ;

de Ruijter, Wouter ;

Delnoij, Thijs S. R. ;

Crijns, Harry J. G. M. ;

Jessurun, Gillian A. J. ;

Oemrawsingh, Pranobe V. ;

Gosselink, Marcel T. M. ;

Plomp, Koos ;

Magro, Michael ;

Elbers, Paul W. G. ;

van de Ven, Peter M. ;

Oudemans-van Straaten, Heleen M. ;

van Royen, Niels .

NEW ENGLAND JOURNAL OF MEDICINE, 2019, 380 (15) :1397-1407

[19] Standardized Bleeding Definitions for Cardiovascular Clinical Trials A Consensus Report From the Bleeding Academic Research Consortium [J].

Mehran, Roxana ;

Rao, Sunil V. ;

Bhatt, Deepak L. ;

Gibson, C. Michael ;

Caixeta, Adriano ;

Eikelboom, John ;

Kaul, Sanjay ;

Wiviott, Stephen D. ;

Menon, Venu ;

Nikolsky, Eugenia ;

Serebruany, Victor ;

Valgimigli, Marco ;

Vranckx, Pascal ;

Taggart, David ;

Sabik, Joseph F. ;

Cutlip, Donald E. ;

Krucoff, Mitchell W. ;

Ohman, E. Magnus ;

Steg, Philippe Gabriel ;

White, Harvey .

CIRCULATION, 2011, 123 (23) :2736-U144

[20] Rationale and design of: A Randomized tRial of Expedited transfer to a cardiac arrest center for non-ST elevation out-of-hospital cardiac arrest: The ARREST randomized controlled trial [J].

Patterson, Tiffany ;

Perkins, Alexander ;

Perkins, Gavin D. ;

Clayton, Tim ;

Evans, Richard ;

Nguyen, Hanna ;

Wilson, Karen ;

Whitbread, Mark ;

Hughes, Johanna ;

Fothergill, Rachael T. ;

Nevett, Joanne ;

Mosweu, Iris ;

McCrone, Paul ;

Dalby, Miles ;

Rakhit, Roby ;

MacCarthy, Philip ;

Perera, Divaka ;

Nolan, Jerry P. ;

Redwood, Simon R. .

AMERICAN HEART JOURNAL, 2018, 204 :92-101

← 1 2 3 →