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Effect of timing of coronary angiography on mortality after out-of-hospital cardiac arrest in elderly patients: a substudy of the TOMAHAWK trial

The optimal timing of coronary angiography in elderly patients after out-of-hospital cardiac arrest (OHCA) without ST-segment elevations after successful resuscitation remains uncertain. This substudy of the randomized TOMAHAWK trial investigated the prognostic impact of immediate vs. delayed/select...

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Main Authors: Thevathasan, Tharusan (Author) , Pugachova, Svitlana (Author) , Pöss, Janine (Author) , Roßberg, Michelle (Author) , Landmesser, Ulf (Author) , Skurk, Carsten (Author) , Fichtlscherer, Stephan (Author) , Akın, Ibrahim (Author) , Fuernau, Georg (Author) , Hassager, Christian (Author) , Zeymer, Uwe (Author) , Preusch, Michael R (Author) , Graf, Tobias (Author) , Feistritzer, Hans-Josef (Author) , Jobs, Alexander (Author) , Schulze, P Christian (Author) , de Waha, Suzanne (Author) , Thiele, Holger (Author) , Freund, Anne (Author) , Desch, Steffen (Author)
Format: Article (Journal)
Language:English
Published: 07 November 2025
In: European heart journal - acute cardiovascular care
Year: 2025, Pages: zuaf144$p1-7
ISSN:2048-8734
DOI:10.1093/ehjacc/zuaf144
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1093/ehjacc/zuaf144
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Author Notes:Tharusan Thevathasan, Svitlana Pugachova, Janine Pöss, Michelle Roßberg, Ulf Landmesser, Carsten Skurk, Stephan Fichtlscherer, Ibrahim Akin, Georg Fuernau, Christian Hassager, Uwe Zeymer, Michael R. Preusch, Tobias Graf, Hans-Josef Feistritzer, Alexander Jobs, P. Christian Schulze, Suzanne de Waha, Holger Thiele, Anne Freund, and Steffen Desch on behalf of the TOMAHAWK Investigators
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Summary:The optimal timing of coronary angiography in elderly patients after out-of-hospital cardiac arrest (OHCA) without ST-segment elevations after successful resuscitation remains uncertain. This substudy of the randomized TOMAHAWK trial investigated the prognostic impact of immediate vs. delayed/selective coronary angiography in elderly vs. younger OHCA survivors.A total of 529 patients with successfully resuscitated OHCA of presumed cardiac origin without ST-segment elevations on post-resuscitation electrocardiograms were analysed. Patients had been randomized to immediate or delayed/selective coronary angiography after 24 h at the earliest. Patients were stratified by age: elderly patients defined as >75 years vs. younger patients as ≤75 years. The primary endpoint was 30-day mortality. Multivariable Cox regression models were applied. Elderly patients exhibited a greater burden of cardiovascular comorbidities, had higher 30-day mortality (69% vs. 43%, P < 0.001), and had higher rates of death or severe neurologic deficit (75% vs. 51%, P < 0.001) compared to younger individuals. In adjusted analyses, the timing of coronary angiography was not significantly associated with mortality in either elderly patients (HR 0.96, 95% CI, 0.59-1.56, P = 0.88) or younger patients (HR 0.88, 95% CI, 0.56-1.38, P = 0.57), with no evidence of effect modification by age (P for interaction = 0.758).Routine immediate coronary angiography does not appear to modify mortality risk in both elderly and younger OHCA survivors without ST-segment elevations. The results do not support differential treatment strategies across age groups.
Item Description:Gesehen am 13.01.2026
Physical Description:Online Resource
ISSN:2048-8734
DOI:10.1093/ehjacc/zuaf144

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