COACT

Population

• Patients successfully resuscitated after cardiac arrest without signs of ST-segment elevation myocardial infarction.

Intervention

Immediate coronary angiography, with PCI if indicated.

Comparator

Coronary angiography delayed until after neurologic recovery, with PCI if indicated.

Key results

• Ninety-day survival: 176 of 273 (64.5%) with immediate angiography vs 178 of 265 (67.2%) with delayed angiography; OR 0.89 (95% CI 0.62-1.27; p=0.51).
• Median time to target temperature was 5.4 hours with immediate angiography vs 4.7 hours with delayed angiography (ratio of geometric means 1.19; 95% CI 1.04-1.36).
• No significant differences were found in the remaining secondary end points.

Harms

• Immediate angiography delayed time to target temperature compared with delayed angiography.
• No significant differences were found in major bleeding, acute kidney injury, or the remaining secondary end points.

Practice impact

• After successful resuscitation without ST-segment elevation, delay coronary angiography until after neurologic recovery rather than going immediately to the lab.

Applicability

• Most applicable to patients resuscitated after out-of-hospital cardiac arrest who do not have signs of STEMI.

Limitations

• Results do not apply to patients with ST-segment elevation myocardial infarction.
• Immediate angiography delayed time to target temperature.
• The primary end point was 90-day survival; most secondary end points also did not differ.

Common misinterpretations

• Immediate angiography is still indicated when STEMI is present; COACT excluded those patients.
• A strategy that was not better than delayed angiography does not mean angiography is never useful; delayed angiography with PCI if indicated was the comparator.