Methodology: 4/5
Usefulness: 4/5

Desch S, et al. N Engl J Med. 2021 Aug 29. doi: 10.1056/NEJMoa2101909.

Question and Methods: This multi-center, open label RCT of 558 patients with OHCA without ST elevation on their ECG compared 30-day all-cause mortality between immediate and delayed coronary angiography.
Findings: There was no significant difference in all-cause mortality between the immediate (54%) and delayed angiography (46%) groups (HR 1.28; 1.00-1.63, p=0.06).
Limitations: Limitations include a lack of blinding and substantial crossover between treatment arms, however, this is mitigated by the authors performing a sensitivity analysis.

Interpretation: Patients with OHCA without STEMI on ECG should no longer have routine immediate angiography done. However, we should still consider immediate angiography in patients with a concerning history for a cardiac cause or STEMI-equivalents on ECG.

By: Dr. Chirag Bhat

Authors

  • Dr. Chirag Bhat is an FRCPC Emergency Medicine resident in the Department of Emergency Medicine, at the University of Ottawa.

  • Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.