Highlights of ESC Congress 2021: TOMAHAWK Trial

In a Hot Line session today, Professor Steffen (Germany) presented results from the large randomized, open-label TOMAHAWK trial, which undertook to provide a definitive position on the use of early angiography in patients with shockable or non-shockable rhythm. The trial randomized 554 patients with return of spontaneous circulation after OUT OF HOSPITAL CARDIAC ARREST with no obvious extracardiac origin of cardiac arrest and no ST-segment elevation/left bundle-branch block on post-resuscitation electrocardiogram to either immediate coronary angiography or initial intensive care unit (ICU) assessment with delayed/selective angiography in a 1:1 ratio. The primary endpoint was all-cause mortality at 30 days. Immediate coronary angiography did not reduce all-cause mortality, with a 30-day rate of 54% compared with 46% for delayed/selective angiography with a hazard ratio [HR] 1.28 There were no differences in the primary endpoint between the different approaches in any prespecified subgroups, including patients with shockable vs. non-shockable rhythm. The composite secondary endpoint of all-cause death or severe neurological deficit at 30 days occurred more frequently in the immediate angiography group compared with the delayed/selective group with a relative risk of 1.16 There were no differences between immediate and delayed/selective angiography in other secondary endpoints, such as length of ICU stay, peak troponin release or myocardial infarction, or in safety endpoints, including moderate or severe bleeding, stroke, and acute renal failure requiring renal replacement therapy. COACT was restricted to patients with shockable rhythm and TOMAHAWK extends the findings to patients with non-shockable rhythm, but both trials showed that early angiography was not superior to a delayed/selective approach. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.