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Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI) after restoration of spontaneous circulation following cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains debated. We hypothesize that immediate CAG and PCI, if indicated, will improve 90-day survival in post–cardiac arrest patients without signs of STEMI. In a prospective, multicenter, randomized controlled clinical trial, 552 post–cardiac arrest patients with restoration of spontaneous circulation and without signs of STEMI will be randomized in a 1:1 fashion to immediate CAG and PCI (within 2 hours) versus initial deferral with CAG and PCI after neurological recovery. The primary end point of the study is 90-day survival. The secondary end points will include 90-day survival with good cerebral performance or minor/moderate disability, myocardial injury, duration of inotropic support, occurrence of acute kidney injury, need for renal replacement therapy, time to targeted temperature control, neurological status at intensive care unit discharge, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, and reasons for discontinuation of treatment. The COACT trial is a multicenter, randomized, controlled clinical study that will evaluate the effect of an immediate invasive coronary strategy in post–cardiac arrest patients without STEMI on 90-day survival.

To the Editor: In their article on the Coronary Angiography after Cardiac Arrest (COACT) trial, Lemkes et al. (April 11 issue) 1 report no survival benefit with immediate angiography among patients without ST-segment elevation myocardial infarction (STEMI) after out-of-hospital cardiac arrest. Revascularization was recommended for unstable coronary lesions, which were defined as stenosis of at least 70%, with irregularity, dissection, haziness, or thrombus on angiography. However, lesions in acute coronary syndrome frequently have less than 70% stenosis, and angiography is suboptimal to detect plaque disruption. 2 We studied 199 patients who had undergone immediate angiography after an out-of-hospital cardiac arrest. 3 Among the . . .