The Year in Cardiology

Coronary Interventions: The Year in Cardiology 2019

Andreas Baumbach; Christos V. Bourantas; PatrickW. Serruys; William Wijns


Eur Heart J. 2020;41(3):394-405. 

In This Article

Revascularization in Patients With Cardiac Arrest or Acute Coronary Syndromes

Coronary Angiography after Cardiac Arrest (COACT) is a landmark study that changed the management of patients admitted with a cardiac arrest who had successful resuscitation and no ST elevation myocardial infarction (STEMI).[1] In this prospective multicentre trial, 552 patients admitted with an out of hospital cardiac arrest with an initial shockable rhythm who did not have an obvious non-cardiac cause of arrest were randomized to immediate coronary angiography and if needed coronary revascularization or delayed coronary angiography after neurological recovery. An acute thrombotic occlusion was noted only in 3.4% of the patients in the immediate angiography and in 7.6% of the patient in the delayed angiography group. Survival rate at discharge (65.2% vs. 68.7%) and at 90-day follow-up (64.5% vs. 67.2%) was not different between randomization groups. In addition, there was no difference for the incidence of the composite endpoint survival with good cerebral performance or mild or moderate disability (62.9% vs. 64.4%). These findings contradict previous observational studies that penalized a delayed invasive assessment of the coronary artery anatomy and justify both approaches in this setting.

Conversely, the Complete vs. Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI (COMPLETE) study confirmed the value of an aggressive revascularization strategy in patients admitted with a STEMI.[2] In this study, 4041 patients who had multivessel CAD were randomized in a 1:1 ratio to complete revascularization vs. culprit-lesion-only PCI. At 3-year follow-up, the incidence of the composite endpoint cardiovascular death or myocardial infarction (MI) was lower in patients undergoing complete revascularization as compared to the patients that had PCI only in the culprit vessel (7.8% vs. 10.5%; P = 0.004); of note, the benefit of complete revascularization was similar in patients who had an in-hospital second procedure compared to a procedure following readmission within 45 days post-discharge; however, this comparison was not randomized, as the choice for timing of the second procedure was left to operator's discretion. The prognostic value of complete revascularization in patients with non-STEMI has not been fully investigated yet.