Emergency versus delayed coronary angiography in survivors of hospital cardiac arrest, without ST-segment elevation.
By Dr Jonathan Shurlock
Dr Caroline Hauw-Berlemont (on behalf of the EMERGE investigators) has recently provided further much needed data into the role of coronary angiogram following out-of-hospital cardiac arrest (OHCA).1 This topic remains contentious with no formal guidance on which patients are appropriate for emergency transfer to the cath lab and those for whom a delayed approach is more suitable.
This multi-centre randomised trial randomised OHCA survivors without ST-segment elevation on admission ECG to immediate or delayed coronary angiogram (Delayed was classified as 48-96 hours post presentation). The authors used 180 day survival with a cerebral performance category (CPC) score of 2 or less as their primary outcome.
279 patients (mean [SD] age, 64.7 [14.6] years) were randomised, 141 into the emergency angiography group and 138 into delayed. The 180-day survival rate among patients with a CPC of 2 or less were 34.1% in the emergency group and 30.7% in the delayed group (hazard ratio [HR], 0.87; 95% CI, 0.65-1.15). There was no difference between groups in the overall survival rate at 180 days (36.2% versus 33.3%; HR, 0.86; 95% CI, 0.64-1.15). There was no difference in secondary outcomes between the two groups.
The authors concluded that though the study was underpowered they found no evidence of better outcomes with an emergency angiography strategy versus delayed for OHCA patients without ST-Segment elevation on ECG.
While this study adds further evidence to inform discussions around the most appropriate strategy for these patients, it is clear that we remain someway from formal recommendations for the management of such patients.
Hauw-Berlemont C, Lamhaut L, Diehl J, et al. Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial. JAMA Cardiol. Published online June 08, 2022. doi:10.1001/jamacardio.2022.1416