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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, May 13, 2019

The COACT Trial

REBEL Cast Episode 66 - Written by Salim Rezaie - May 13, 2019
Author Conclusion: “Among patients who had been successfully resuscitated after out-of-hospital cardiac arrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days.”
Clinical Take Home Point: We agree with the authors conclusions that immediate vs delayed angiography does not affect 90 day mortality in patients with cardiac arrest without STEMI. It is important to note that the majority of patients who had cardiac arrest in this study did not have unstable coronary lesions as the cause of their cardiac arrest (which is the probable reality of this group of patients) therefore the majority of patients who had angiography did not even require PCI. This study is the best evidence we have to date that shows not all cardiac arrests , even those with shockable rhythms need a heart catheterization. So the bottom line for us is:
  • Cardiac Arrest + STEMI on ECG = Cath Lab
  • Cardiac Arrest + No STEMI on ECG = Dependent on patient factors + conversation with interventional cardiologist (It may be reasonable to not cath immediately and wait 24 – 48hrs before doing a heart cath, if at all)