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

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Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. / Desch, Steffen; Freund, Anne; Akin, Ibrahim; Behnes, Michael; Preusch, Michael R.; Zelniker, Thomas A.; Skurk, Carsten; Landmesser, Ulf; Graf, Tobias; Eitel, Ingo; Fuernau, Georg; Haake, Hendrik; Nordbeck, Peter; Hammer, Fabian; Felix, Stephan B.; Hassager, Christian; Engstrom, Thomas; Fichtlscherer, Stephan; Ledwoch, Jakob; Lenk, Karsten; Joner, Michael; Steiner, Stephan; Liebetrau, Christoph; Voigt, Ingo; Zeymer, Uwe; Brand, Michael; Schmitz, Roland; Horstkotte, Jan; Jacobshagen, Claudius; Poss, Janine; Abdel-Wahab, Mohamed; Lurz, Philipp; Jobs, Alexander; de Waha-Thiele, Suzanne; Olbrich, Denise; Sandig, Frank; Koenig, Inke R.; Brett, Sabine; Vens, Maren; Klinge, Kathrin; Thiele, Holger; TOMAHAWK Investigators.

I: New England Journal of Medicine, Bind 385, 2021, s. 2544-2553.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt

Harvard

Desch, S, Freund, A, Akin, I, Behnes, M, Preusch, MR, Zelniker, TA, Skurk, C, Landmesser, U, Graf, T, Eitel, I, Fuernau, G, Haake, H, Nordbeck, P, Hammer, F, Felix, SB, Hassager, C, Engstrom, T, Fichtlscherer, S, Ledwoch, J, Lenk, K, Joner, M, Steiner, S, Liebetrau, C, Voigt, I, Zeymer, U, Brand, M, Schmitz, R, Horstkotte, J, Jacobshagen, C, Poss, J, Abdel-Wahab, M, Lurz, P, Jobs, A, de Waha-Thiele, S, Olbrich, D, Sandig, F, Koenig, IR, Brett, S, Vens, M, Klinge, K, Thiele, H & TOMAHAWK Investigators 2021, 'Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation', New England Journal of Medicine, bind 385, s. 2544-2553. https://doi.org/10.1056/NEJMoa2101909

APA

Desch, S., Freund, A., Akin, I., Behnes, M., Preusch, M. R., Zelniker, T. A., Skurk, C., Landmesser, U., Graf, T., Eitel, I., Fuernau, G., Haake, H., Nordbeck, P., Hammer, F., Felix, S. B., Hassager, C., Engstrom, T., Fichtlscherer, S., Ledwoch, J., ... TOMAHAWK Investigators (2021). Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. New England Journal of Medicine, 385, 2544-2553. https://doi.org/10.1056/NEJMoa2101909

Vancouver

Desch S, Freund A, Akin I, Behnes M, Preusch MR, Zelniker TA o.a. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. New England Journal of Medicine. 2021;385:2544-2553. https://doi.org/10.1056/NEJMoa2101909

Author

Desch, Steffen ; Freund, Anne ; Akin, Ibrahim ; Behnes, Michael ; Preusch, Michael R. ; Zelniker, Thomas A. ; Skurk, Carsten ; Landmesser, Ulf ; Graf, Tobias ; Eitel, Ingo ; Fuernau, Georg ; Haake, Hendrik ; Nordbeck, Peter ; Hammer, Fabian ; Felix, Stephan B. ; Hassager, Christian ; Engstrom, Thomas ; Fichtlscherer, Stephan ; Ledwoch, Jakob ; Lenk, Karsten ; Joner, Michael ; Steiner, Stephan ; Liebetrau, Christoph ; Voigt, Ingo ; Zeymer, Uwe ; Brand, Michael ; Schmitz, Roland ; Horstkotte, Jan ; Jacobshagen, Claudius ; Poss, Janine ; Abdel-Wahab, Mohamed ; Lurz, Philipp ; Jobs, Alexander ; de Waha-Thiele, Suzanne ; Olbrich, Denise ; Sandig, Frank ; Koenig, Inke R. ; Brett, Sabine ; Vens, Maren ; Klinge, Kathrin ; Thiele, Holger ; TOMAHAWK Investigators. / Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. I: New England Journal of Medicine. 2021 ; Bind 385. s. 2544-2553.

Bibtex

@article{127e45f1f318422e9352cbb73e055436,

title = "Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation",

abstract = "BackgroundMyocardial 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.MethodsIn 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.ResultsA 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.ConclusionsAmong 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.",

keywords = "ACUTE MYOCARDIAL-INFARCTION, PERCUTANEOUS CORONARY INTERVENTION, INSIGHTS, SURVIVORS, DESIGN, ELECTROCARDIOGRAM, RATIONALE, DIAGNOSIS, TROPONIN",

author = "Steffen Desch and Anne Freund and Ibrahim Akin and Michael Behnes and Preusch, {Michael R.} and Zelniker, {Thomas A.} and Carsten Skurk and Ulf Landmesser and Tobias Graf and Ingo Eitel and Georg Fuernau and Hendrik Haake and Peter Nordbeck and Fabian Hammer and Felix, {Stephan B.} and Christian Hassager and Thomas Engstrom and Stephan Fichtlscherer and Jakob Ledwoch and Karsten Lenk and Michael Joner and Stephan Steiner and Christoph Liebetrau and Ingo Voigt and Uwe Zeymer and Michael Brand and Roland Schmitz and Jan Horstkotte and Claudius Jacobshagen and Janine Poss and Mohamed Abdel-Wahab and Philipp Lurz and Alexander Jobs and {de Waha-Thiele}, Suzanne and Denise Olbrich and Frank Sandig and Koenig, {Inke R.} and Sabine Brett and Maren Vens and Kathrin Klinge and Holger Thiele and {TOMAHAWK Investigators}",

year = "2021",

doi = "10.1056/NEJMoa2101909",

language = "English",

volume = "385",

pages = "2544--2553",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachusetts Medical Society",

}

RIS

TY - JOUR

T1 - Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation

AU - Desch, Steffen

AU - Freund, Anne

AU - Akin, Ibrahim

AU - Behnes, Michael

AU - Preusch, Michael R.

AU - Zelniker, Thomas A.

AU - Skurk, Carsten

AU - Landmesser, Ulf

AU - Graf, Tobias

AU - Eitel, Ingo

AU - Fuernau, Georg

AU - Haake, Hendrik

AU - Nordbeck, Peter

AU - Hammer, Fabian

AU - Felix, Stephan B.

AU - Hassager, Christian

AU - Engstrom, Thomas

AU - Fichtlscherer, Stephan

AU - Ledwoch, Jakob

AU - Lenk, Karsten

AU - Joner, Michael

AU - Steiner, Stephan

AU - Liebetrau, Christoph

AU - Voigt, Ingo

AU - Zeymer, Uwe

AU - Brand, Michael

AU - Schmitz, Roland

AU - Horstkotte, Jan

AU - Jacobshagen, Claudius

AU - Poss, Janine

AU - Abdel-Wahab, Mohamed

AU - Lurz, Philipp

AU - Jobs, Alexander

AU - de Waha-Thiele, Suzanne

AU - Olbrich, Denise

AU - Sandig, Frank

AU - Koenig, Inke R.

AU - Brett, Sabine

AU - Vens, Maren

AU - Klinge, Kathrin

AU - Thiele, Holger

AU - TOMAHAWK Investigators

PY - 2021

Y1 - 2021

N2 - BackgroundMyocardial 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.MethodsIn 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.ResultsA 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.ConclusionsAmong 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.

AB - BackgroundMyocardial 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.MethodsIn 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.ResultsA 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.ConclusionsAmong 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.

KW - ACUTE MYOCARDIAL-INFARCTION

KW - PERCUTANEOUS CORONARY INTERVENTION

KW - INSIGHTS

KW - SURVIVORS

KW - DESIGN

KW - ELECTROCARDIOGRAM

KW - RATIONALE

KW - DIAGNOSIS

KW - TROPONIN

U2 - 10.1056/NEJMoa2101909

DO - 10.1056/NEJMoa2101909

M3 - Journal article

C2 - 34459570

VL - 385

SP - 2544

EP - 2553

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

ER -

ID: 279628863