Trial DesignCoronary angiography after cardiac arrest: Rationale and design of the COACT trial
Section snippets
Study design
COACT is a prospective, multicenter, randomized, controlled clinical study evaluating the effect of an immediate CAG in patients after OHCA on 90-day survival. A total of 14 centers in the Netherlands will enroll patients. These centers are all high-volume PCI centers with 24/7 STEMI service and extensive experience treating OHCA patients. Patients are eligible for the study if they have ventricular tachycardia or fibrillation during the arrest, have restoration of spontaneous circulation
Discussion
The effect of an immediate invasive strategy in patients after OHCA and without ECG signs of STEMI has been debated for some time. Several observational studies have reported on the effect of immediate CAG in OHCA patients on survival.6., 8., 9., 10., 11., 12., 13., 14., 15., 16., 17., 18. However, only a few have done so in the specific group of patients without signs of STEMI. Bro-Jeppesen et al15 found that immediate CAG was not associated with a reduction in mortality (HR adjusted = 0.69,
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2021, Kidney MedicineThe effect of immediate coronary angiography after cardiac arrest without ST-segment elevation on left ventricular function. A sub-study of the COACT randomised trial
2021, ResuscitationCitation Excerpt :The COACT trial was an investigator-initiated, randomized, open-label, multicentre trial comparing immediate coronary angiography with delayed coronary angiography in patients successfully resuscitated from cardiac arrest without ST-segment elevation on the ECG. The trial design has been published previously.7 The protocol was designed by the principal authors and was approved by the steering committee (Supplementary Appendix) and all relevant ethics committees.
Data on sex differences in one-year outcomes of out-of-hospital cardiac arrest patients without ST-segment elevation
2020, Data in BriefCitation Excerpt :Important exclusion criteria were signs of ST-segment elevation, shock or an obvious non-coronary cause [1]. Further in- and exclusion criteria were reported previously [3]. Eligible patients for the study were randomized in a 1:1 ratio to either immediate coronary angiography (i.e. within two hours after randomization) or delayed coronary angiography strategy until after neurological recovery.
Coronary angiographic findings after cardiac arrest in relation to ECG and comorbidity
2020, ResuscitationCitation Excerpt :Previous retrospective studies present somewhat conflicting results3,6,13–15 thereby limiting the strength of current guidelines. Several ongoing randomized studies addressing this important question are currently including patients, and the results from these will certainly provide more knowledge about optimal strategy and timing concerning angiography.16,17 No difference in survival or neurologic outcome could be found in the newly published, first randomized trial investigating this important issue8 The finding in this trial of a lower rate of PCI (33% in patients randomized to immediate coronary angiography) compared to many of the previously published retrospective studies is interesting.
Trial registration number: NTR 4973 (www.trialregister.nl).