Key result
Early/immediate coronary angiography did not reduce all-cause death compared to a delayed/selective strategy in patients with out-of-hospital cardiac arrest without ST-segment elevation.
Why the study?
Whether selected subgroups, specifically those with a high pretest probability of coronary artery disease, benefit from early coronary angiography after OHCA without ST-segment elevation remains unclear.
Does early/immediate coronary angiography reduce all-cause death in patients with out-of-hospital cardiac arrest and no ST-segment elevation?
Meta-Analysis (n=1,512)
Yes
Does early/immediate coronary angiography reduce all-cause death in patients with out-of-hospital cardiac arrest and no ST-segment elevation?
Answers are grounded in this paper and cite their sources.
In patients with out-of-hospital cardiac arrest without ST-segment elevation, a strategy of early/immediate coronary angiography does not reduce all-cause mortality compared to a delayed/selective approach.
BACKGROUND: Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear. METHODS: We included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects. RESULTS: In total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91-1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89-1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00-2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82-1.33, P = 0.74; P-interaction 0.097). CONCLUSION: In OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG.
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Hamidi et al. (2023) conducted a meta-analysis in Out-of-hospital cardiac arrest without ST-segment elevation (n=1,512). Early/immediate coronary angiography vs. Delayed/selective coronary angiography was evaluated on All-cause death (OR 1.12, 95% CI 0.91-1.38, p=0.28). Early/immediate coronary angiography did not reduce all-cause death compared to a delayed/selective strategy in patients with out-of-hospital cardiac arrest without ST-segment elevation.
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