At five years, survival was comparable between immediate and delayed angiography with no clinical benefit or harm in patients without ST-segment elevation resuscitated from out-of-hospital cardiac arrest (OHCA), according to new results from the randomized COACT trial published Feb. 4 in JACC.

The open-label, multicenter study included 552 patients (mean age 66 years, 19% women) across 19 centers in the Netherlands from Jan. 8, 2018, to July 17, 2018. The main results showed no difference at 90 days in survival between the two treatment groups. Subsequent follow-up was at one and five years through structured telephone interviews. For this analysis, data were available for 514 patients.

Results at five years found that 55% and 52% of the patients in the immediate angiography and delayed angiography groups were alive (hazard ratio [HR] 0.95; log-rank p=0.072). Cumulative 90-day and five-year mortality was about 10%.

In a hypothesis-generating landmark analysis that was not prespecified, the HRs for death to 90 days and >90 days were 1.11 and 0.56, respectively. Moreover, researchers found a “divergence of the survival curves about [three] years after arrest in favor of the immediate angiography group.”

No between-group differences were observed for the secondary endpoints of ICD shocks, heart failure-related hospitalizations, repeat revascularization and myocardial infarction at five years.

Among the limitations of the study, Eva Marie Spoormans, MD, et al., note the lack of power calculation for the long-term follow-up, the open-label design and inability to extrapolate the results to patients with ST-segment elevation, cadiogenic shock or hemodynamic instability post arrest.

Regarding the landmark analysis, they write: “Whether this finding reflects a true long-term benefit of immediate angiography remains uncertain and may reflect chance, requiring further data from follow-up of other trials.”