- Question
- In patients resuscitated from out-of-hospital cardiac arrest without ST-segment elevation, does immediate coronary angiography improve survival compared with a delayed or selective strategy?
- Design
- Multicenter, randomized, open-label (unmasked) trial that assigned 554 patients to immediate angiography or to initial intensive care assessment with delayed or selective angiography; the primary analysis included 530 patients.
- Population
- Patients successfully resuscitated from out-of-hospital cardiac arrest of possible coronary origin, with no ST-segment elevation on the postresuscitation electrocardiogram.
- Intervention
- Immediate coronary angiography, with revascularization when appropriate.
- Control
- Initial intensive care assessment to determine the cause of arrest, with delayed or selective angiography only if indicated.
- Primary outcome
- Death from any cause at 30 days.
- Results
- At 30 days, 143 of 265 patients (54.0%) in the immediate-angiography group and 122 of 265 (46.0%) in the delayed-angiography group had died (HR 1.28; 95% CI 1.00 to 1.63; P = 0.06). The composite of death or severe neurologic deficit was more frequent with the immediate strategy (64.3% vs. 55.6%; RR 1.16; 95% CI 1.00 to 1.34).
- Safety
- Peak troponin release and the incidence of moderate or severe bleeding, stroke, and renal-replacement therapy were similar in both groups.
- Conclusion
- In patients resuscitated from out-of-hospital cardiac arrest without ST-segment elevation, immediate angiography provided no benefit over a delayed or selective strategy for 30-day all-cause mortality.
- Why it matters
- The trial supported not performing routine immediate coronary angiography in these patients, reserving it for those with an indication after initial intensive care assessment.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026