Key result
Early coronary angiography shows no mortality benefit over delayed angiography in OHCA without ST elevation.
Why the study?
The optimal timing and role of early coronary angiography in out-of-hospital cardiac arrest patients without ST-segment elevation remains unclear.
Does early coronary angiography reduce mortality or improve neurological status in patients with out-of-hospital cardiac arrest without ST-segment elevation?
Meta-Analysis (n=1,625)
Does early coronary angiography reduce mortality or improve neurological status in patients with out-of-hospital cardiac arrest without ST-segment elevation?
Effect estimate: OR 1.22 (95% CI 0.99-1.50)
p-value: p=0.06
Early coronary angiography does not improve survival or neurological outcomes compared to a delayed strategy in patients with out-of-hospital cardiac arrest without ST-segment elevation.
Supports delayed angiography in OHCA without ST elevation; confirms neutral mortality effect in pooled evidence.
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) has a poor prognosis. The optimal timing and role of early coronary angiography (CAG) in OHCA patients without ST-segment elevation remains unclear. The goal of this study is to compare an early CAG versus delayed CAG strategy in OHCA patients without ST elevation. METHODS: We systematically searched PubMed, Embase and Cochrane databases, in June 2022, for randomised controlled trials (RCTs) comparing early versus delayed early CAG. A random effects meta-analysis was performed. RESULTS: A total of seven RCTs were included, providing a total of 1625 patients: 816 in an early strategy and 807 in a delayed strategy. In terms of outcomes assessed, our meta-analysis revealed a similar rate of all-cause mortality (pooled odds ratio [OR] 1.22 [0.99-1.50], P = 0.06, I 2 = 0%), neurological status (pooled OR 0.94 [0.74-1.21], = 0.65, I 2 = 0%), need of renal replacement therapy (pooled OR 1.11 [0.78-1.74], P = 0.47, I 2 = 0%) and major bleeding events (pooled OR 1.51 [0.95-2.40], P = 0.08, I 2 = 69%). CONCLUSION: According to our meta-analysis, in patients who experienced OHCA without ST elevation, early CAG is not associated with reduced mortality or an improved neurological status.
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Costa et al. (2023) conducted a meta-analysis in Out-of-hospital cardiac arrest without ST-segment elevation (n=1,625). Early coronary angiography vs. Delayed coronary angiography was evaluated on All-cause mortality (OR 1.22, 95% CI 0.99-1.50, p=0.06). Early coronary angiography was not associated with reduced all-cause mortality compared to delayed angiography in patients with OHCA without ST elevation (OR 1.22; 95% CI 0.99-1.50; P=0.06).
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