Key result
Early coronary angiography was associated with increased survival overall (OR 1.40; 95% CI 1.12-1.76), but this effect was not significant in the subgroup of randomized trials (OR 0.89; P=0.29).
Why the study?
The study aimed to assess the effect of early coronary angiography compared with selective coronary angiography in patients after out-of-hospital cardiac arrest without ST-elevation myocardial infarction.
Does early coronary angiography improve survival and/or neurological outcomes in patients after out-of-hospital cardiac arrest without ST-elevation myocardial infarction?
Population
Patients after NSTE-OHCA across 16 included studies (six RCTs, ten NRS)
Comparison
Early CAG vs selective CAG (late and no CAG)
Design
Network meta-analysis of RCTs and non-randomized studies
Authors
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Does not support routine early CAG in NSTE-OHCA; challenges survival benefit reported in observational data.
Meta-Analysis
Does early coronary angiography improve survival and/or neurological outcomes in patients after out-of-hospital cardiac arrest without ST-elevation myocardial infarction?
Odds Ratio: 1.4 (95% CI 1.12–1.76)
p-value: p=< 0.01
This network meta-analysis demonstrates that the previously reported survival benefit of early coronary angiography in NSTE-OHCA is driven by biased observational data, whereas RCTs show no benefit, not supporting routine early CAG.
Heyne et al. (2022) conducted a meta-analysis in Out-of-hospital cardiac arrest without ST-elevation myocardial infarction (NSTE-OHCA). Early coronary angiography vs. Selective coronary angiography (late and no CAG) was evaluated on Survival (OR 1.40, 95% CI 1.12-1.76, p=< 0.01). Early coronary angiography was associated with increased survival overall (OR 1.40; 95% CI 1.12-1.76), but this effect was not significant in the subgroup of randomized trials (OR 0.89; P=0.29).