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EMCrit Podcast 243 – The COACT Trial on Early vs. Delayed Cath after Cardiac Arrest without STEMI

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Hot off the press is the COACT trial randomizing patients to immediate vs. delayed cardiac catheterization after cardiac arrest. I had this on my list to do a ‘cast on, but EMCrit Team Member Felipe Teran beat me to it. He interviews past show guest and the lead author of the editorial on the paper, Ben Abella. The trial only included patients with an initial shockable rhythm and they were still unconscious. STEMIs went right to the lab.

COACT Trial

  • Actual Paper1
  • Editorial2

This comes right at the heels of the AHA statement by Yannopoulos et al. recommending a more aggressive stance on immediate cath.3

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Now on to the Podcast…

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1.
Lemkes JS, Janssens GN, van der Hoeven NW, et al. Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. N Engl J Med. March 2019. doi:10.1056/nejmoa1816897
2.
Abella BS, Gaieski DF. Coronary Angiography after Cardiac Arrest — The Right Timing or the Right Patients? N Engl J Med. March 2019. doi:10.1056/nejme1901651
3.
Yannopoulos D, Bartos JA, Aufderheide TP, et al. The Evolving Role of the Cardiac Catheterization Laboratory in the Management of Patients With Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation. 2019;139(12). doi:10.1161/cir.0000000000000630

Scott Weingart

An ED Intensivist from NY. No conflicts of interest (coi).

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Cite this post as:

Scott Weingart. EMCrit Podcast 243 – The COACT Trial on Early vs. Delayed Cath after Cardiac Arrest without STEMI. EMCrit Blog. Published on March 31, 2019. Accessed on December 12th 2019. Available at [https://emcrit.org/emcrit/coact-trial/ ].

Financial Disclosures

Unless otherwise noted at the top of the post, the speaker(s) and related parties have no relevant financial disclosures.

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Mike Jasumback

Does this reflect, to some degree, the variation in practice between the Netherlands and the US. I.e. in the studied patients there were few “Intervenable lesions”. We know that if you take 10 cardiologists, show them a cath you will get 20 different opinions on whether a lesion is “intervenable”. At this point, I think the validity of this study may be supported by this issue. Will be interested to see if the next few RCTs show the same outcomes. Then… We will be very interested in the behavior of the AHA writing group. Will they bend to RCT data? or will they bend to their financial interests?

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8 months ago
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