Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest

Cyril Camaro, Judith L Bonnes, Eddy M Adang, Eva M Spoormans, Gladys N Janssens, Nina W van der Hoeven, Lucia S Jewbali, Eric A Dubois, Martijn Meuwissen, Tom A Rijpstra, Hans A Bosker, Michiel J Blans, Gabe B Bleeker, Rémon Baak, George J Vlachojannis, Bob J Eikemans, Pim van der Harst, Iwan C van der Horst, Michiel Voskuil, Joris J van der HeijdenBert Beishuizen, Martin Stoel, Hans van der Hoeven, José P Henriques, Alexander P Vlaar, Maarten A Vink, Bas van den Bogaard, Ton A Heestermans, Wouter de Ruijter, Thijs S Delnoij, Harry J Crijns, Gillian A Jessurun, Pranobe V Oemrawsingh, Marcel T Gosselink, Koos Plomp, Michael Magro, Paul W Elbers, Peter M van de Ven, Jorrit S Lemkes, Niels van Royen

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Background In patients with out-of-hospital cardiac arrest without ST-segment elevation, immediate coronary angiography did not improve clinical outcomes when compared with delayed angiography in the COACT (Coronary Angiography After Cardiac Arrest) trial. Whether 1 of the 2 strategies has benefits in terms of health care resource use and costs is currently unknown. We assess the health care resource use and costs in patients with out-of-hospital cardiac arrest. Methods and Results A total of 538 patients were randomly assigned to a strategy of either immediate or delayed coronary angiography. Detailed health care resource use and cost-prices were collected from the initial hospital episode. A generalized linear model and a gamma distribution were performed. Generic quality of life was measured with the RAND-36 and collected at 12-month follow-up. Overall total mean costs were similar between both groups (EUR 33 575±19 612 versus EUR 33 880±21 044; P=0.86). Generalized linear model: (β, 0.991; 95% CI, 0.894-1.099; P=0.86). Mean procedural costs (coronary angiography and percutaneous coronary intervention, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384±3447 versus EUR 3028±4220; P<0.001). Costs concerning intensive care unit and ward stay did not show any significant difference. The RAND-36 questionnaire did not differ between both groups. Conclusions The mean total costs between patients with out-of-hospital cardiac arrest randomly assigned to an immediate angiography or a delayed invasive strategy were similar during the initial hospital stay. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered. Registration URL:; Unique identifier: NL4857.

Original languageEnglish
Article numbere022238
Pages (from-to)e022238
JournalJournal of the American Heart Association
Issue number5
Publication statusPublished - 1 Mar 2022


  • coronary angiography
  • health care costs
  • non–ST‐segment–elevation myocardial infarction
  • out‐of‐hospital cardiac arrest

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