{"id":"01eca33a8611","type":"article","url":"https://hartvaat.nl/2021/12/30/angiografie-na-buitenziekenhuis-hartstilstand-zonder-st-elevatie-nejm-tomahawk/","title":"Angiografie na buitenziekenhuis-hartstilstand zonder ST-elevatie: NEJM TOMAHAWK","title_en":"Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2101909","source_url":"https://doi.org/10.1056/NEJMoa2101909","authors":["Steffen Desch","Anne Freund","Ibrahim Akin","Michael Behnes","Michael R Preusch","Thomas A Zelniker","Carsten Skurk","Ulf Landmesser","Tobias Graf","Ingo Eitel","Georg Fuernau","Hendrik Haake","Peter Nordbeck","Fabian Hammer","Stephan B Felix","Christian Hassager","Thomas Engstrøm","Stephan Fichtlscherer","Jakob Ledwoch","Karsten Lenk","Michael Joner","Stephan Steiner","Christoph Liebetrau","Ingo Voigt","Uwe Zeymer","Michael Brand","Roland Schmitz","Jan Horstkotte","Claudius Jacobshagen","Janine Pöss","Mohamed Abdel-Wahab","Philipp Lurz","Alexander Jobs","Suzanne de Waha-Thiele","Denise Olbrich","Frank Sandig","Inke R König","Sabine Brett","Maren Vens","Kathrin Klinge","Holger Thiele"],"significance":9,"published":"2021-12-30","source_date":"2021-12-30","image":"","kennis":[],"congress":"","summary_en":"The TOMAHAWK trial confirmed that immediate coronary angiography did not improve 30-day survival compared with a delayed approach in patients resuscitated from out-of-hospital cardiac arrest without ST-segment elevation. Together with COACT, this definitively argued against routine emergent catheterization in this setting.","created":"2026-07-03T10:29:34Z","updated":"2026-07-03T13:28:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM TOMAHAWK trial die onmiddellijke versus uitgestelde angiografie vergeleek na hartstilstand zonder ST-elevatie. Bevestigt COACT: geen voordeel van onmiddellijke strategie.","abstract_original":"BACKGROUND: Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest. However, the benefits of early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST-segment elevation are unclear. METHODS: In this multicenter trial, we randomly assigned 554 patients with successfully resuscitated out-of-hospital cardiac arrest of possible coronary origin to undergo either immediate coronary angiography (immediate-angiography group) or initial intensive care assessment with delayed or selective angiography (delayed-angiography group). All the patients had no evidence of ST-segment elevation on postresuscitation electrocardiography. The primary end point was death from any cause at 30 days. Secondary end points included a composite of death from any cause or severe neurologic deficit at 30 days. RESULTS: A total of 530 of 554 patients (95.7%) were included in the primary analysis. At 30 days, 143 of 265 patients (54.0%) in the immediate-angiography group and 122 of 265 patients (46.0%) in the delayed-angiography group had died (hazard ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.63; P = 0.06). The composite of death or severe neurologic deficit occurred more frequently in the immediate-angiography group (in 164 of 255 patients [64.3%]) than in the delayed-angiography group (in 138 of 248 patients [55.6%]), for a relative risk of 1.16 (95% CI, 1.00 to 1.34). Values for peak troponin release and for the incidence of moderate or severe bleeding, stroke, and renal-replacement therapy were similar in the two groups. CONCLUSIONS: Among patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation, a strategy of performing immediate angiography provided no benefit over a delayed or selective strategy with respect to the 30-day risk of death from any cause. (Funded by the German Center for Cardiovascular Research; TOMAHAWK ClinicalTrials.gov number, NCT02750462.)."}