Acute cardiac care & resuscitation

Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: One-Year Outcomes of a Randomized Clinical Trial

JAMA CardiolPublished Secondary analysis of the TOMAHAWK randomised trial

Primary result · All-cause mortalityResult — go to the resultHazard ratio 1.25 95% CI 0.99–1.57

Authors' conclusion

This study found that a strategy of immediate coronary angiography does not provide clinical benefit compared with a delayed or selective invasive approach for patients 1 year after resuscitated OHCA of presumed coronary cause and without ST-segment elevation.

Study context

Population
Resuscitated out-of-hospital cardiac arrest (OHCA) of presumed cardiac origin with stable return of spontaneous circulation, without ST-segment elevation on postresuscitation ECG
Participants
554 participants
Comparison
Immediate vs delayed or selective coronary angiography
  • Immediate angiographyn = 281
  • Delayed or selectiven = 273reference
Primary endpoint
All-cause mortality
Follow-up
1 year
Methodological detailsmulticentre, international (Germany and Denmark), investigator-initiated, open-label
  • Multicentre
  • International (Germany and Denmark)
  • Investigator-initiated
  • Open-label

Primary result

As reported in the abstract

Hazard ratio

1.25

95% CI 0.99–1.57

P = 0.05

Events by treatment group

Immediate angiography vs Delayed or selective
HR 1.25 (95% CI 0.99–1.57); P = 0.05

Further findings

Severe neurologic deficit, MI, rehospitalization for congestive HF (survivors at 1 year)

Similar between the groups

Original publication

Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: One-Year Outcomes of a Randomized Clinical Trial. JAMA Cardiol. Published 1 September 2023. doi:10.1001/jamacardio.2023.2264

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