Open Access
27-07-2023 | Angiography | Original Paper
Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials
Authors:
Fardin Hamidi, Elaaha Anwari, Christian Spaulding, Caroline Hauw-Berlemont, Aurélie Vilfaillot, Ana Viana-Tejedor, Karl B. Kern, Chiu-Hsieh Hsu, Brian A. Bergmark, Arman Qamar, Deepak L. Bhatt, Remo H. M. Furtado, Peder L. Myhre, Christian Hengstenberg, Irene M. Lang, Norbert Frey, Anne Freund, Steffen Desch, Holger Thiele, Michael R. Preusch, Thomas A. Zelniker
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.
Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials
Authors
Fardin Hamidi Elaaha Anwari Christian Spaulding Caroline Hauw-Berlemont Aurélie Vilfaillot Ana Viana-Tejedor Karl B. Kern Chiu-Hsieh Hsu Brian A. Bergmark Arman Qamar Deepak L. Bhatt Remo H. M. Furtado Peder L. Myhre Christian Hengstenberg Irene M. Lang Norbert Frey Anne Freund Steffen Desch Holger Thiele Michael R. Preusch Thomas A. Zelniker