Key result
Early coronary angiography significantly decreased long-term mortality by 34% compared to delayed or no angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation.
Why the study?
Early coronary angiography remains controversial in post-cardiac arrest patients without ST-segment elevation.
Does early coronary angiography improve mortality and neurological outcomes in post-cardiac arrest patients without ST-segment elevation?
Meta-Analysis (n=4,737)
Does early coronary angiography improve mortality and neurological outcomes in post-cardiac arrest patients without ST-segment elevation?
Odds Ratio: 0.66 (95% CI 0.51–0.85)
p-value: p=0.002
Early coronary angiography in out-of-hospital cardiac arrest patients without ST-segment elevation is associated with decreased long-term mortality and improved neurological outcomes, though these findings are driven by observational data rather than randomized trials.
May support early angiography in post-arrest patients without STE; extends observational data but leaves randomized confirmation open.
Background: Early coronary angiography (CAG) is a subject of controversy in post-cardiac arrest patients who do not exhibit ST-segment elevation. The objective of this meta-analysis was to evaluate the effect it had on outcomes. Methods: A comprehensive search of Medline and Cochrane yielded 16 studies [of which 9 were observational and 7 were randomized controlled trials (RCTs)] involving 4737 patients. 95% confidence intervals accompanied odds ratios (ORs) were generated by a random-effects model. Meta-regression explored factors modifying effect sizes. Results: Early coronary angiography (CAG) decreased long-term mortality significantly [OR: 0.66 (0.51-0.85)], improved favorable coronary prothrombotic scores [Cerebral Performance Category (CPC) 1-2] at discharge [OR: 1.49 (1.09-2.03)], and suggested a trend toward increased percutaneous coronary intervention after CAG [OR: 1.07 (0.75-1.53)]. In contrast to the RCT subgroup, the observational study subgroup exhibited reduced rates of short- and long-term mortality, as well as CPC1-2 at discharge. Meta-regression revealed that type 2 diabetes mellitus and follow-up time influence short-term mortality and CPC 1-2 at discharge, respectively. Conclusion: Observational studies demonstrated that early CAG in post-cardiac arrest patients without ST elevation is associated with long-term clinical benefits. Caveat should be exercised when interpreting.
No takes yet. Share an insight, caveat, or question.
Azhar et al. (2025) conducted a meta-analysis in Out-of-hospital cardiac arrest without ST-segment elevation (n=4,737). Early coronary angiography vs. Delayed or no coronary angiography was evaluated on Long-term mortality (OR 0.66, 95% CI 0.51-0.85, p=0.002). Early coronary angiography significantly decreased long-term mortality by 34% compared to delayed or no angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: