Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial.
BACKGROUND
The clinical importance of immediate coronary angiography, with potentially subsequent percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility and safety aspects of performing immediate coronary angiography in a pre-specified pilot phase of the 'DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest' (DISCO) randomized controlled trial (ClinicalTrials.gov ID: NCT02309151).


METHODS
Resuscitated bystander witnessed OHCA patients >18 years without ST-elevation on the ECG were randomized to immediate coronary angiography versus standard of care. Event times, procedure related adverse events and safety variables within 7 days were recorded.


RESULTS
In total, 79 patients were randomized to immediate angiography (n = 39) or standard of care (n = 40). No major differences in baseline characteristics between the groups were found. There were no differences in the proportion of bleedings and renal failure. Three patients randomized to immediate angiography and six patients randomized to standard care died within 24 h. The median time from EMS arrival to coronary angiography was 135 min in the immediate angiography group. In patients randomized to immediate angiography a culprit lesion was found in 14/38 (36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized to standard of care, coronary angiography was performed before the stipulated 3 days.


CONCLUSION
In this out-of-hospital cardiac arrest population without ST-elevation, randomization to a strategy to perform immediate coronary angiography was feasible although the time window of 120 min from EMS arrival at the scene of the arrest to start of coronary angiography was not achieved. No significant safety issues were reported.
['Elfwén|Ludvig|L|', 'Lagedal|Rickard|R|', 'Nordberg|Per|P|', 'James|Stefan|S|', 'Oldgren|Jonas|J|', 'Böhm|Felix|F|', 'Lundgren|Peter|P|', 'Rylander|Christian|C|', 'van der Linden|Jan|J|', 'Hollenberg|Jacob|J|', 'Erlinge|David|D|', 'Cronberg|Tobias|T|', 'Jensen|Ulf|U|', 'Friberg|Hans|H|', 'Lilja|Gisela|G|', 'Larsson|Ing-Marie|IM|', 'Wallin|Ewa|E|', 'Rubertsson|Sten|S|', 'Svensson|Leif|L|']
D000368:Aged D017023:Coronary Angiography D005240:Feasibility Studies D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D058687:Out-of-Hospital Cardiac Arrest D062645:Percutaneous Coronary Intervention D010865:Pilot Projects D013997:Time Factors
Coronary angiography Out-of-hospital Cardiac arrest Percutaneous coronary intervention