This study depicts that Despite advances in the fields of resuscitation and intensive care management, the outcome of out-of-hospital cardiac arrest remains poor. Optimal care after out-of-hospital cardiac arrest and successful resuscitation includes targeted temperature management, vital organ support, and treatment of the underlying cause of the arrest. The cause of the arrest is often unclear immediately after the event, in particular in the absence of ST-segment elevation (STE) on ECG. This lack of a definitive diagnosis can lead to uncertainty about the appropriate treatment.

Patients who survive cardiac arrest have a high prevalence of coronary artery disease and if myocardial infarction is the cause of the arrest, immediate coronary angiography and percutaneous coronary intervention might improve outcome. Previous observation studies reported a survival benefit of an immediate invasive strategy in patients who were resuscitated from cardiac arrest even in the absence of STE myocardial infarction compared with historical controls.1,2 However, these outcomes might have been an effect of the observational nature of these studies, which may have resulted in selection bias that favored selecting patients who had a presumed better prognosis for immediate angiography.

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