The results showed no significant difference between the two groups in terms of survival at 90 days, the trial's primary endpoint. Survival was better than expected in both groups, with 64.5 percent of those receiving immediate intervention and 67.2 percent of those receiving delayed intervention alive 90 days after their cardiac arrest. Researchers say the findings may reflect the fact that clearing the arteries with PCI sooner after cardiac arrest does not necessarily reduce the likelihood of long-term brain damage, which is a key factor in survival after cardiac arrest.
"We'd hoped that sending these patients for immediate catheterization would improve outcomes, but I think there are some explanations for why we found what we found," Lemkes said. "One is that the primary cause of death in this patient group is neurological injury, and it is difficult to imagine how immediate catheterization would address that."
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Previous trials have suggested cooling the body can improve outcomes for patients after cardiac arrest. An analysis of secondary outcomes revealed patients who received delayed intervention achieved the target body temperature more quickly, after an average of 4.7 hours compared to 5.4 hours in the group receiving immediate intervention. However, this trend did not translate to a significant survival benefit.
The timing of angiography did not appear to make difference in regard to other secondary outcomes relevant to the degree of brain damage, kidney problems, bleeding and other common complications after cardiac arrest.
Lemkes said that the study's moderate sample size and the higher-than-expected survival rate may have limited the study's statistical power. In addition, the trial's findings are relevant only to non-STEMI patients after cardiac arrest, not to STEMI patients or those experiencing cardiogenic shock. He added that the results of several other ongoing trials may shed more light on the optimal timing of angiography in non-STEMI patients or help to identify subgroups who may be more likely to benefit from immediate intervention.
The study received funding from Biotronik, AstraZeneca and the Netherlands Heart Institute.
This study was simultaneously published online in the New England Journal of Medicine at the time of presentation.
The ACC's Annual Scientific Session will take place March 16-18, 2019, in New Orleans, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention.