Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation - TOMAHAWK

Contribution To Literature:

The TOMAHAWK trial failed to show that early coronary angiography was beneficial to initial intensive care management among patients with out-of-hospital cardiac arrest.

Description:

The goal of the trial was to evaluate early coronary angiography compared with initial intensive care management with delayed/selective coronary angiography among patients who suffered an out-of-hospital cardiac arrest of possible coronary origin.

Study Design

  • Randomization
  • Parallel

Participants with out-of-hospital cardiac arrest of possible coronary origin were randomized to early coronary angiography (n = 265) versus initial intensive care management with delayed/selective coronary angiography (n = 265).

  • Total number of enrollees: 530
  • Duration of follow-up: 30 days
  • Median patient age: 70 years
  • Percentage female: 30.4%
  • Percentage with diabetes: 29%

Inclusion criteria:

  • Out-of-hospital cardiac arrest
  • No ST-segment elevation on post-resuscitation electrocardiography

Principal Findings:

The primary outcome, all-cause mortality at 30 days, was 54.0% in the early coronary angiography group compared with 46.0% in the initial intensive care management group (p = 0.06).

Secondary outcomes:

  • Death or severe neurologic deficit: 64.3% in the early coronary angiography group compared with 55.6% in the initial intensive care management group

Interpretation:

Among patients with out-of-hospital cardiac arrest of possible coronary origin, a strategy of early coronary angiography was not beneficial compared to initial intensive care management with delayed/selective coronary angiography. Early coronary angiography did not improve 30-day survival, or death or severe neurologic deficit.

References:

Desch S, Freund A, Akin I, et al., on behalf of the TOMAHAWK Investigators. Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation. N Engl J Med 2021;Aug 29:[Epub ahead of print].

Presented by Dr. Steffen Desch at the European Society of Cardiology Virtual Congress, August 29, 2021.

Keywords: ESC21, ESC Congress, Acute Coronary Syndrome, Arrhythmias, Cardiac, Coronary Angiography, Coronary Vessels, Critical Care, Electrocardiography, Heart Arrest, Heart Failure, Neurology, Out-of-Hospital Cardiac Arrest, Secondary Prevention


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