Role of coronary angiography in patients with a non-diagnostic electrocardiogram following out of hospital cardiac arrest: Rationale and design of the multicentre randomized controlled COUPE trial

Eur Heart J Acute Cardiovasc Care. 2020 Nov;9(4_suppl):S131-S137. doi: 10.1177/2048872618813843. Epub 2019 Jun 25.

Abstract

Background: Coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA). The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following cardiac arrest in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear.

Aims: We aim to assess whether emergency CAG and PCI, when indicated, will improve survival with good neurological outcome in post-OHCA patients without STEMI who remain comatose.

Methods: COUPE is a prospective, multicentre and randomized controlled clinical trial. A total of 166 survivors of OHCA without STEMI will be included. Potentially non-cardiac aetiology of the cardiac arrest will be ruled out prior to randomization. Randomization will be 1:1 for emergency (within 2 h) or deferred (performed before discharge) CAG. Both groups will receive routine care in the intensive cardiac care unit, including therapeutic hypothermia. The primary efficacy endpoint is a composite of in-hospital survival free of severe dependence, which will be evaluated using the Cerebral Performance Category Scale. The safety endpoint will be a composite of major adverse cardiac events including death, reinfarction, bleeding and ventricular arrhythmias.

Conclusions: This study will assess the efficacy of an emergency CAG versus a deferred one in OHCA patients without STEMI in terms of survival and neurological impairment.

Keywords: Out-of-hospital cardiac arrest; coronary angiography; neurological outcome; non-diagnostic electrocardiogram; percutaneous coronary intervention; survival.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Cardiopulmonary Resuscitation / methods*
  • Coronary Angiography / methods*
  • Electrocardiography*
  • Emergency Service, Hospital*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypothermia, Induced / methods*
  • Male
  • Out-of-Hospital Cardiac Arrest / diagnosis*
  • Out-of-Hospital Cardiac Arrest / therapy
  • Prospective Studies