Role of coronary angiography in patients with a non-diagnostic electrocardiogram following out of hospital cardiac arrest: Rationale and design of the multicentre randomized controlled COUPE trial. Issue 4 (November 2020)

• Record Type: Journal Article
• Authors: Viana-Tejedor, Ana; Ariza-Solé, Albert; Martínez-Sellés, Manuel; Mena, Manuel Jiménez; Vila, Montserrat; García, Cosme; García Acuña, JM; Bañeras, Jordi; García Rubira, Juan C; Pérez, Pablo J; Querol, Carlos T; Pastor, Gemma; Andrea, Rut; Osorio, Pablo L; Alonso, Norberto; Martínez, Cristina; Pérez Rodríguez, María; Noriega, Francisco J; Ferrera, Carlos; Salinas, Pablo; Gil, Iván Núñez; Ortiz, Antonio Fernández; Macaya, Carlos
• Is Part Of: European heart journal. Volume 9:Issue 4(2020)Supplement
• Page Start: S131
• Page End: S137
• Publication Date: 2020-11
• Subjects: Out-of-hospital cardiac arrest -- coronary angiography -- non-diagnostic electrocardiogram -- percutaneous coronary intervention -- survival -- neurological outcome; 616.1205
• DOI: 10.1177/2048872618813843
• Languages: English
• ISSNs: 2048-8726

Abstract

Background: Coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA). The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following cardiac arrest in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear. Aims: We aim to assess whether emergency CAG and PCI, when indicated, will improve survival with good neurological outcome in post-OHCA patients without STEMI who remain comatose. Methods: COUPE is a prospective, multicentre and randomized controlled clinical trial. A total of 166 survivors of OHCA without STEMI will be included. Potentially non-cardiac aetiology of the cardiac arrest will be ruled out prior to randomization. Randomization will be 1:1 for emergency (within 2 h) or deferred (performed before discharge) CAG. Both groups will receive routine care in the intensive cardiac care unit, including therapeutic hypothermia. The primary efficacy endpoint is a composite of in-hospital survival free of severe dependence, which will be evaluated using the Cerebral Performance Category Scale. The safety endpoint will be a composite of major adverse cardiac events including death, reinfarction, bleeding and ventricular arrhythmias. Conclusions: This study will assess the efficacy of an emergency CAG versus a deferred one in OHCA patients without STEMI in terms of survival and neurological impairment.