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==Population== | ==Population== | ||
===Inclusion Criteria=== | ===Inclusion Criteria=== | ||
* 30 years | * Aged ≥30 years | ||
* Out of hospital cardiac arrest (OHCA) of possible cardiac origin with ROSC | |||
* Shockable and unshockable rhythms included | * Shockable and unshockable rhythms included | ||
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* ST elevation or LBBB | * ST elevation or LBBB | ||
* No ROSC | * No ROSC | ||
* | * Severe hemodynamic or electrical instability that would indicate urgent coronary angiography and likely intervention | ||
* | * Non-cardiac origin of OHCA (e.g., TBI, metabolic disorder, electrolyte disorder, intoxication, hemorrhage, lung disease leading to respiratory failure, suffocation, drowning) | ||
* In-hospital | |||
* | * Pregnancy | ||
* | |||
===Baseline Characteristics=== | ===Baseline Characteristics=== | ||
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==Interventions== | ==Interventions== | ||
* Randomized to | * Randomized to a group: | ||
* Immediate angiography | ** '''Immediate angiography''' - Brought to cath lab ASAP after admission | ||
* Delayed angiography | ** '''Delayed angiography''' - Initial ICU care to stratify OHCA etiology, with later coronary angiography if indicated. | ||
** | *** Coronary angiography was allowed in first 24 hours if ≥1 of the following: | ||
*** Troponin 70x ULN or CK-MB 10x ULN | **** Troponin 70x ULN or CK-MB 10x ULN | ||
*** Electrical instability | **** Electrical instability | ||
*** Cardiogenic shock | **** Cardiogenic shock | ||
*** New ST elevations | **** New ST elevations | ||
* Both groups revascularized by PCI if at least one culprit lesion | * Both groups revascularized by PCI if at least one culprit lesion; CABG allowed if thought to be more appropriate | ||
==Outcomes== | ==Outcomes== | ||
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===Subgroup Analysis=== | ===Subgroup Analysis=== | ||
The primary outcome was similar by age of 65 years, diabetes, type of first rhythm, use of TTM. | The primary outcome was similar by age of 65 years, diabetes, type of first rhythm, use of TTM. While the authors did not note any large differences in the primary outcome by these subgroups, the WJC editors note that the point estimate for the primary estimate was closer to "null" than "harm" with immediate angiography among those with confirmed MI as OHCA (with very wide CIs given small numbers in this group), among men, and ROSC ≥15 min from arrest. The WJC authors do not think there were obvious signals of potential benefit from immediate angiography in these groups. | ||
; Out of hospital cardiac arrest confirmed as MI | ; Out of hospital cardiac arrest confirmed as MI | ||