Key result
Early coronary angiography reduced long-term mortality compared to delayed or no angiography in patients with out-of-hospital cardiac arrest without ST elevation.
Why the study?
The impact of early coronary angiography on outcomes in post-cardiac arrest patients without ST-segment elevation remains a topic of debate.
Does early coronary angiography improve mortality and neurological outcomes in patients with out-of-hospital cardiac arrest without ST elevation?
Meta-Analysis (n=4,737)
Does early coronary angiography improve mortality and neurological outcomes in patients with out-of-hospital cardiac arrest without ST elevation?
Early coronary angiography is associated with improved long-term mortality and neurological outcomes in out-of-hospital cardiac arrest patients without ST elevation, though these benefits are primarily driven by observational data rather than randomized trials.
Answers are grounded in this paper and cite their sources.
Early CAG may improve survival and neurology in OHCA without STE; leaves open confirmation in dedicated RCTs.
Background: Early coronary angiography (CAG) in post-cardiac arrest patients without ST-segment elevation is a topic of debate. This meta-analysis aimed to assess its impact on outcomes. Methods: A search of Medline and Cochrane up to February 2023 was conducted to identify randomized controlled trials and observational studies comparing patients undergoing early CAG vs. delayed/no CAG after experiencing out-of-hospital cardiac arrest. A random-effects model pooled odds ratios (ORs) with 95% confidence intervals (CIs). Meta-regression explored factors modifying effect sizes. Results: We identified 16 studies (7 RCTs, 9 observational studies) involving 4,737 patients. Early CAG significantly reduced long-term mortality [OR: 0.66 (0.51-0.85)], and increased favorable cerebral performance category (CPC) 1-2 at discharge [OR: 1.49 (1.09-2.03)]. Observational study subgroup showed decreased short-term mortality, long-term mortality, and CPC 1-2 at discharge, unlike RCT subgroup. Meta-regression revealed type 2 diabetes mellitus and follow-up time influencing short-term mortality and CPC 1-2 at discharge, respectively. Conclusion: Early CAG in post-cardiac arrest patients without ST elevation is associated with long-term clinical benefits, particularly evident in observational studies. Interpretation should be cautious.
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Ahmed et al. (2024) 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 reduced long-term mortality compared to delayed or no angiography in patients with out-of-hospital cardiac arrest without ST elevation.
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