title: Coronary angiography after cardiac arrest: Rationale and design of the COACT trial.
abstract: BACKGROUND
  Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI) after restoration of spontaneous circulation following cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains debated.
  
  
  OBJECTIVE
  We hypothesize that immediate CAG and PCI, if indicated, will improve 90-day survival in post-cardiac arrest patients without signs of STEMI.
  
  
  METHODS
  In a prospective, multicenter, randomized controlled clinical trial, 552 post-cardiac arrest patients with restoration of spontaneous circulation and without signs of STEMI will be randomized in a 1:1 fashion to immediate CAG and PCI (within 2 hours) versus initial deferral with CAG and PCI after neurological recovery. The primary end point of the study is 90-day survival. The secondary end points will include 90-day survival with good cerebral performance or minor/moderate disability, myocardial injury, duration of inotropic support, occurrence of acute kidney injury, need for renal replacement therapy, time to targeted temperature control, neurological status at intensive care unit discharge, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, and reasons for discontinuation of treatment.
  
  
  CONCLUSIONS
  The COACT trial is a multicenter, randomized, controlled clinical study that will evaluate the effect of an immediate invasive coronary strategy in post-cardiac arrest patients without STEMI on 90-day survival.
authors.affiliation: Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands. Electronic address: j.lemkes@vumc.nl.
authors.forename: Jorrit S
authors.initials: JS
authors.lastname: Lemkes
authors.affiliation: Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Gladys N
authors.initials: GN
authors.lastname: Janssens
authors.affiliation: Department of Intensive care medicine, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Heleen M Oudemans-van
authors.initials: HM
authors.lastname: Straaten
authors.affiliation: Department of Intensive care medicine, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Elbers
authors.affiliation: Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Nina W
authors.initials: NW
authors.lastname: van der Hoeven
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Luuk C
authors.initials: LC
authors.lastname: Otterspoor
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Voskuil
authors.affiliation: Department of Intensive care medicine, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Joris J
authors.initials: JJ
authors.lastname: van der Heijden
authors.affiliation: Department of Cardiology, Amphia Hospital, Breda, the Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Meuwissen
authors.affiliation: Department of Intensive care medicine, Amphia Hospital, Breda, the Netherlands.
authors.forename: Tom A
authors.initials: TA
authors.lastname: Rijpstra
authors.affiliation: Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands.
authors.forename: Georgios J
authors.initials: GJ
authors.lastname: Vlachojannis
authors.affiliation: Department of Intensive care medicine, Maasstad Hospital, Rotterdam, the Netherlands.
authors.forename: Raoul M
authors.initials: RM
authors.lastname: van der Vleugel
authors.affiliation: Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Koen
authors.initials: K
authors.lastname: Nieman
authors.affiliation: Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Lucia S D
authors.initials: LS
authors.lastname: Jewbali
authors.affiliation: Department of Cardiology, HAGA Hospital, Den Haag, the Netherlands.
authors.forename: Gabe B
authors.initials: GB
authors.lastname: Bleeker
authors.affiliation: Department of Intensive care medicine, HAGA Hospital,Den Haag, the Netherlands.
authors.forename: Rémon
authors.initials: R
authors.lastname: Baak
authors.affiliation: Department of Intensive care medicine, Medical Centre Twente, Enschede, the Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: Beishuizen
authors.affiliation: Department of Cardiology, Medical Centre Twente, Enschede, the Netherlands.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Stoel
authors.affiliation: Department of Cardiology, University Medical Centre, Groningen, the Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: van der Harst
authors.affiliation: Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Cyril
authors.initials: C
authors.lastname: Camaro
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: José P S
authors.initials: JP
authors.lastname: Henriques
authors.affiliation: Department of Cardiology, OLVG hospital, Amsterdam, the Netherlands.
authors.forename: Maarten A
authors.initials: MA
authors.lastname: Vink
authors.affiliation: Department of Cardiology, Isala klinieken, Zwolle, the Netherlands.
authors.forename: Marcel T M
authors.initials: MT
authors.lastname: Gosselink
authors.affiliation: Department of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Hans A
authors.initials: HA
authors.lastname: Bosker
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.affiliation: Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Niels
authors.initials: N
authors.lastname: van Royen
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D006801:Humans; D057194:Intention to Treat Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012107:Research Design; D061665:Time-to-Treatment