Key result
Early coronary angiography showed no significant difference in mortality compared to delayed angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation.
Why the study?
While immediate coronary angiography is recommended for OHCA with ST-elevation, its effect on mortality and neurological outcomes in OHCA patients without ST-elevation remained to be evaluated.
Does early coronary angiography reduce mortality in patients with out-of-hospital cardiac arrest without ST-segment elevation?
Meta-Analysis
Does early coronary angiography reduce mortality in patients with out-of-hospital cardiac arrest without ST-segment elevation?
Early coronary angiography does not provide survival or neurological benefits compared to delayed angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation.
Answers are grounded in this paper and cite their sources.
Does not support routine early angiography in OHCA without ST elevation; confirms equivalent mortality and neurological outcomes with delayed strategy.
Introduction: Out-of-hospital cardiac arrest (OHCA) is defined as the loss of functional mechanical activity of the heart in association with an absence of systemic circulation, occurring outside of a hospital. Immediate coronary angiography (CAG) with percutaneous coronary intervention is recommended for OHCA with ST-elevation. We aimed to evaluate the effect of early CAG on mortality and neurological outcomes in OHCA patients without ST-elevation. Methods: This meta-analysis and systemic review was conducted as per principles of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) group. A protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, Ref No. = CRD42022327833). A total of 674 studies were retrieved after scanning several databases (PubMed Central, EMBASE, Medline, and Cochrane Central Register of Controlled Trials). Results: A total of 18 studies were selected for the final analysis, including 6 randomized control trials and 12 observational studies. Statistically, there was no significant difference in primary outcome, i.e., mortality, between early and delayed CAG. In terms of the grade of neurological recovery as a secondary outcome, early and delayed CAG groups also showed no statistically significant difference. Conclusion: Early CAG has no survival benefits in patients with no ST elevations on ECG after OHCA.
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Rashid et al. (2024) conducted a meta-analysis in Out-of-hospital cardiac arrest without ST-segment elevation. Early coronary angiography vs. Delayed coronary angiography was evaluated on Mortality. Early coronary angiography showed no significant difference in mortality compared to delayed angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation.
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