{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T15:41:10Z","timestamp":1786722070874,"version":"build-2736575974"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"Importance<\/jats:title>Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest (OHCA). The long-term effect of early coronary angiography on patients with OHCA with possible coronary trigger but no ST-segment elevation remains unclear.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the clinical outcomes of early unselective angiography with the clinical outcomes of a delayed or selective approach for successfully resuscitated patients with OHCA of presumed cardiac origin without ST-segment elevation at 1-year follow-up.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>The TOMAHAWK trial was a multicenter, international (Germany and Denmark), investigator-initiated, open-label, randomized clinical trial enrolling 554 patients between November 23, 2016, to September 20, 2019. Patients with stable return of spontaneous circulation after OHCA of presumed cardiac origin but without ST-segment elevation on the postresuscitation electrocardiogram were eligible for inclusion. A total of 554 patients were randomized to either immediate coronary angiography after hospital admission or an initial intensive care assessment with delayed or selective angiography after a minimum of 24 hours. All 554 patients were included in survival analyses during the follow-up period of 1 year. Secondary clinical outcomes were assessed only for participants alive at 1 year to account for the competing risk of death.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Early vs delayed or selective coronary angiography and revascularization if indicated.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Evaluations in this secondary analysis included all-cause mortality after 1 year, as well as severe neurologic deficit, myocardial infarction, and rehospitalization for congestive heart failure in survivors at 1 year.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 281 patients were randomized to the immediate angiography group and 273 to the delayed or selective group, with a median age of 70 years (IQR, 60-78 years). A total of 369 of 530 patients (69.6%) were male, and 268 of 483 patients (55.5%) had a shockable arrest rhythm. At 1 year, all-cause mortality was 60.8% (161 of 265) in the immediate angiography group and 54.3% (144 of 265) in the delayed or selective angiography group without significant difference between the treatment strategies, trending toward an increase in mortality with immediate angiography (hazard ratio, 1.25; 95% CI, 0.99-1.57; P<\/jats:italic>\u2009=\u2009.05). For patients surviving until 1 year, the rates of severe neurologic deficit, myocardial infarction, and rehospitalization for congestive heart failure were similar between the groups.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study found that a strategy of immediate coronary angiography does not provide clinical benefit compared with a delayed or selective invasive approach for patients 1 year after resuscitated OHCA of presumed coronary cause and without ST-segment elevation.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT02750462<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2023.2264","type":"journal-article","created":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T15:02:20Z","timestamp":1691593340000},"page":"827","source":"Crossref","is-referenced-by-count":22,"title":["Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation"],"prefix":"10.1001","volume":"8","author":[{"given":"Steffen","family":"Desch","sequence":"first","affiliation":[{"name":"Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine\/Cardiology, University of Leipzig, Leipzig, Germany"},{"name":"Leipzig Heart Institute, Leipzig, Germany"},{"name":"University Heart Center L\u00fcbeck, L\u00fcbeck, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Freund","sequence":"additional","affiliation":[{"name":"Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine\/Cardiology, University of Leipzig, Leipzig, Germany"},{"name":"Leipzig Heart Institute, Leipzig, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Akin","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), Berlin, Germany"},{"name":"First Department of Medicine, Faculty of Medicine Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Behnes","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), Berlin, Germany"},{"name":"First Department of Medicine, Faculty of Medicine Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Preusch","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), Berlin, Germany"},{"name":"Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Zelniker","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), Berlin, Germany"},{"name":"Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany"},{"name":"Division of Cardiology, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Skurk","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), Berlin, Germany"},{"name":"University Clinic Charit\u00e9, Campus Benjamin Franklin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Landmesser","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), Berlin, Germany"},{"name":"University Clinic 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