Coronary Revascularization and Out-of-hospital Cardiac Arrest: Past, Present and Future

Matthew E.Li Kam Wa*, Kalpa De Silva, Nilesh Pareek, Divaka Perera

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Cardiologists and the cardiac catheter laboratory have key roles to play in the management of patients after out-of-hospital cardiac arrest (OHCA). Although immediate catheter laboratory activation is the standard of care in cardiogenic shock and ST elevation myocardial infarction, the majority of patients will present without these features and with an uncertain diagnosis. Even in the latter, early assessment and invasive management may be beneficial, but this is counterbalanced by significant resource utilization, potential to cause harm and the possibility that any diagnostic or therapeutic gains are offset by a poor neurological outcome. Past consensus on the management of the OHCA patient without ST elevation or cardiogenic shock is being challenged by emerging results from new trials in this field. Further randomized trials are ongoing, and are expected to deliver robust data from over 4,000 patients, allowing us to further refine the optimal management strategy in this challenging cohort. This article describes the benefits and pitfalls of a strategy of immediate coronary angiography in these patients, examines the recently published COACT and TOMAHAWK trials in detail, and describes a framework with which to approach the patient after resuscitated OHCA, based on the available evidence to date.

Original languageEnglish
Pages (from-to)94-102
Number of pages9
JournalHeart International
Issue number2
Publication statusPublished - 2021


  • Cardiac catheterization
  • Coronary angiography
  • Non-ST elevation myocardial infarction
  • Out-of-hospital cardiac arrest
  • Percutaneous coronary intervention
  • Real-world clinical trials


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