Key result
Early coronary angiography significantly increased survival to discharge compared to delayed or no angiography in patients with out-of-hospital cardiac arrest without ST segment elevation (OR 1.78).
Why the study?
The necessity of immediate coronary angiography to achieve positive outcomes in patients with out-of-hospital cardiac arrest without ST segment elevation was uncertain.
Does immediate coronary angiography improve survival and neurological outcomes in out-of-hospital cardiac arrest patients without ST segment elevation?
Meta-Analysis (n=3,886)
Does immediate coronary angiography improve survival and neurological outcomes in out-of-hospital cardiac arrest patients without ST segment elevation?
Odds Ratio: 1.78 (95% CI 1.51–2.11)
p-value: p=<0.0001
Immediate coronary angiography may improve short-term survival and neurological outcomes at discharge in OHCA patients without ST-segment elevation, though middle-term survival benefits were not significant.
May support immediate CAG for short-term survival/neurologic benefit in OHCA without STE; leaves open confirmation by RCTs before practice change.
OBJECTIVE: This meta-analysis aimed to review the available evidence and evaluate the necessity of immediate coronary angiography (CAG) to obtain positive outcomes for out-of-hospital cardiac arrest (OHCA) patients without ST segment elevation. DATA SOURCES: Web of Science, PubMed, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed databases. STUDY SELECTION: We included observational and case-control studies of outcomes among individuals without ST segment elevation experiencing OHCA who had immediate, delayed, or no CAG. DATA EXTRACTION: We extracted study details, as well as patient characteristics and outcomes. DATA SYNTHESIS: Six studies (n = 2665) investigating mortality until discharge demonstrated a significant increase in survival benefit with early CAG (odds ratio [OR] = 1.78; 95%CI = 1.51-2.11; I = 81%; P < .0001). Seven studies (n = 2909) showed a significant preservation of neurological functions with early CAG at discharge (OR = 1.66; 95%CI = 1.37-2.02; P < .00001). Four studies (n = 1357) investigating survival outcomes with middle-term follow-up revealed no significant benefit with early CAG (OR = 1.21; 95%CI = 0.93-1.57; I = 66%; P = .15). CONCLUSIONS: Our meta-analysis demonstrates that there may be significant benefits in performing immediate CAG on patients who experience OHCA without ST segment elevation.
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Yang et al. (2020) conducted a meta-analysis in Out-of-hospital cardiac arrest (OHCA) without ST segment elevation (n=3,886). Early coronary angiography vs. Delayed or no coronary angiography was evaluated on Survival until discharge (OR 1.78, 95% CI 1.51-2.11, p=<0.0001). Early coronary angiography significantly increased survival to discharge compared to delayed or no angiography in patients with out-of-hospital cardiac arrest without ST segment elevation (OR 1.78).
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