Immediate vs Delayed Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: 5-Year Outcomes From the COACT Randomized Trial.

For patients without ST-segment elevation after return of spontaneous circulation, the COACT (Coronary Angiography After Cardiac Arrest) trial was the first randomized trial that investigated the benefit of immediate vs delayed coronary angiography with subsequent percutaneous coronary intervention if needed.

对于自发循环恢复后没有ST段抬高的患者，COACT（心脏骤停后的冠状动脉造影）试验是首个随机试验，研究了立即与延迟冠状动脉造影的益处，如果需要，随后进行经皮冠状动脉介入治疗。

No difference in 90-day survival was found.

未发现90天生存率存在差异。

The long-term impact on survival of the 2 treatment strategies remains uncertain.

两种治疗策略对长期生存影响的后果仍然不确定。

The aim of this study was to investigate the 5-year impact on survival of immediate vs delayed coronary angiography in OHCA patients with an initial shockable rhythm and no ST-segment elevation on initial electrocardiography after return of spontaneous circulation.

本研究旨在调查在初始可电击心律且自发循环恢复后初次心电图无ST段抬高的院外心脏骤停患者中，立即与延迟冠状动脉造影对5年生存影响的比较。

Methods

The COACT trial was a randomized, open-label, multicenter study comparing immediate vs delayed coronary angiography in patients resuscitated from OHCA without ST-segment elevation.

COACT试验是一项随机、开放标签、多中心研究，比较了在没有ST段抬高的院外心脏骤停复苏患者中，立即与延迟冠状动脉造影的效果。

Nineteen Dutch centers enrolled patients, and 5-year follow-up was obtained via structured telephone interviews.

十九个荷兰中心招募了患者，并通过结构化的电话访谈获得了5年的随访数据。

Secondary endpoints included myocardial infarction, repeat revascularization, heart failure-related hospitalizations, and implantable cardioverter-defibrillator shocks.

次要终点包括心肌梗死、再次血运重建、心力衰竭相关的住院治疗以及植入式心律转复除颤器的电击治疗。

Results

At 5-year follow-up, data from 514 of 552 patients (93.1%) were available.

在5年的随访中，552名患者中有514名（93.1%）的数据是可用的。

Of these patients, 261 (50.8%) were assigned to immediate angiography and 253 (49.2%) to a delayed strategy.

在这些患者中，有261名（50.8%）被分配到立即进行血管造影，而有253名（49.2%）被分配到延迟策略。

Baseline characteristics were similar across the 2 treatment groups.

两组治疗组的基线特征相似。

Five years after the index hospitalization, 143 patients (54.8%) were alive in the immediate angiography group, and 131 patients (51.8%) were alive in the delayed angiography group (HR: 0.95; 95% CI: 0.74-1.23; log-rank P = 072).

在首次住院后的五年里，立即行血管造影组有143名患者（54.8%）存活，延迟行血管造影组有131名患者（51.8%）存活（HR: 0.95; 95% 置信区间: 0.74-1.23; log-rank P = 0.72）。

In a nonprespecified and exploratory landmark analysis, HRs for death to 90 days and >90 days were 1.11 (95% CI: 0.84-1.49; log-rank P = 0.46) and 0.56 (95% CI: 0.32-0.97; log-rank P = 0.04).

在一项非预先指定的探索性里程碑分析中，90天及90天以上的死亡风险比（HRs）分别为1.11（95%置信区间：0.84-1.49；对数秩检验P=0.46）和0.56（95%置信区间：0.32-0.97；对数秩检验P=0.04）。

Rates of myocardial infarction, heart failure-related hospitalization, and revascularization were low and did not differ between groups.

心肌梗死、心力衰竭相关住院和血运重建的发生率较低，且两组之间无差异。

Conclusions

At 5 years, survival was comparable between immediate and delayed angiography, with no clear benefit or harm.

在5年时，立即和延迟血管造影的生存率相当，没有明确的益处或害处。

A late survival benefit appeared after 90 days, though its clinical significance remains uncertain and most likely is due to chance.

在90天后出现了晚期生存益处，尽管其临床意义仍然不确定，且很可能是因为偶然。

(Coronary Angiography After Cardiac Arrest [COACT]; NTR4973).

(心脏骤停后冠状动脉造影[COACT]; NTR4973).