TOPLINE:

Immediate coronary angiography did not improve 5-year survival compared with delaying the procedure in adults resuscitated from out-of-hospital cardiac arrest without ST-segment elevation. Other major cardiac events were uncommon and similar between groups.

METHODOLOGY:

• Researchers reported 5-year follow-up results from a randomized, open-label trial (COACT) evaluating whether immediate vs delayed coronary angiography after out-of-hospital cardiac arrest without ST-segment elevation improved long-term survival.
• They enrolled adults who remained unconscious after resuscitation from cardiac arrest with an initial shockable rhythm and no ST-segment elevation at 19 centers in the Netherlands between 2015 and 2018. The final analysis included 5-year follow-up data from 514 of 552 enrolled patients.
• Overall, 261 patients were randomly assigned to the immediate angiography group and 253 to the delayed angiography group (mean ages, 65.8 years and 65.3 years, respectively; 81.2% and 77.1% men, respectively).
• The primary endpoint was survival at 5 years. Secondary endpoints included myocardial infarction, revascularization, heart failure-related hospitalization, and implantable cardioverter-defibrillator (ICD) shocks.
• Follow-up data at 1 and 5 years were collected through telephone interviews and verified by general physicians and through hospital records.

TAKEAWAY:

• At 5 years, 54.8% of patients in the immediate angiography group and 51.8% of patients in the delayed angiography group were alive, with no significant difference in the odds for survival between groups (hazard ratio [HR], 0.95; log-rank P = .72).
• The risk for mortality did not differ through 90 days but was lower after 90 days in the immediate vs delayed angiography group (HR, 0.56; log-rank P = .04) in an exploratory landmark analysis.
• Rates of myocardial infarction, repeat revascularization, heart failure-related hospitalization, and ICD shocks were low and did not differ between groups.

IN PRACTICE:

“The 5-year results, as presented here, representing the culmination of the COACT trial, provide durable reassurance that delayed coronary angiography is safe and appropriate, supporting current guidelines. Delaying coronary angiography may not only help preserve hospital resources and allow further diagnostic evaluation and optimal intensive care support,” the researchers of the study wrote.

SOURCE:

This study was led by Eva M. Spoormans, MD, of Amsterdam University Medical Center in Amsterdam, Netherlands. It was published online on February 4, 2026, in JACC.

LIMITATIONS:

The COACT trial was powered for short-term outcomes; thus, the 5-year analysis was considered exploratory. Physicians were aware of treatment allocation, which may have influenced clinical decisions. Findings did not apply to patients with ST-segment elevation, cardiogenic shock, or hemodynamic instability.

DISCLOSURES:

The COACT trial received unrestricted research grants from the Netherlands Heart Institute, AstraZeneca, and Biotronik. One author declared receiving grants from multiple sources including Biotronik and honoraria from Medtronic. Another author reported receiving grants from a medical device and a pharmaceutical company. The remaining authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.