Immediate unselected coronary angiography versus delayed triage in survivors of out-of-hospital cardiac arrest without ST-segment elevation: Design and rationale of the TOMAHAWK trial.

Abstract:

:Patients experiencing out-of-hospital cardiac arrest (OHCA) without ST-segment elevation are a heterogenic group with a variety of underlying causes. Up to one-third of patients display a significant coronary lesion compatible with myocardial infarction as OHCA trigger. There are no randomized data on patient selection and timing of invasive coronary angiography after admission. METHODS AND RESULTS: The TOMAHAWK trial randomly assigns 558 patients with return of spontaneous circulation after OHCA with no obvious extracardiac origin of cardiac arrest and no ST-segment elevation/left bundle-branch block on postresuscitation electrocardiogram to either immediate coronary angiography or initial intensive care assessment with delayed/selective angiography in a 1:1 ratio. The primary end point is 30-day all-cause mortality. Secondary analyses will be performed with respect to initial rhythm, electrocardiographic patterns, myocardial infarction as underlying cause, neurological outcome, as well as clinical and laboratory markers. Clinical follow-up will be performed at 6 and 12 months. Safety end points include bleeding and stroke. CONCLUSION: The TOMAHAWK trial will address the unresolved issue of timing and general indication of angiography after OHCA without ST-segment elevation.

journal_name

Am Heart J

journal_title

American heart journal

authors

Desch S,Freund A,Graf T,Fichtlscherer S,Haake H,Preusch M,Hammer F,Akin I,Christ M,Liebetrau C,Skurk C,Steiner S,Voigt I,Schmitz R,Mudra H,Ledwoch J,Menck N,Horstkotte J,Pels K,Lahmann AL,Otto S,Lenk K,Ohlow M

doi

10.1016/j.ahj.2018.12.005

subject

Has Abstract

pub_date

2019-03-01 00:00:00

pages

20-28

eissn

0002-8703

issn

1097-6744

pii

S0002-8703(18)30341-7

journal_volume

209

pub_type

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