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Coronary Angiography in Out-of-Hospital Cardiac Arrest Patients
Quick Takes
- Results from this meta-analysis show no significant differences in mortality or neurological status among patients with out-of-hospital cardiac arrest without ST-segment elevation who undergo early versus delayed coronary angiography.
- Several randomized clinical trials are ongoing to provide definitive guidance.
Study Questions:
What are clinical outcomes in patients who underwent early versus nonearly coronary angiography (CAG) when presenting with out-of-hospital cardiac arrest (OHCA) without ST-segment elevations?
Methods:
MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from inception until February 21, 2020. Early and nonearly CAG patients were identified on the basis of the definitions mentioned in respective published studies. The primary outcome studied was 30-day mortality. Secondary outcomes were neurological status and the rate of percutaneous coronary intervention (PCI) following cardiac arrest.
Results:
Of 4,516 references, 11 studies enrolling 3,581 patients were included in the final meta-analysis. Random-effects analysis showed no differences in 30-day mortality (risk ratio [RR], 0.86; 95% confidence interval [CI], 0.71-1.04; p = 0.12; I2 = 74%), neurological status (RR, 1.08; 95% CI, 0.94-1.24; p = 0.28; I2 = 69%), and rate of PCI (RR, 1.22; 95% CI, 0.94-1.59; p = 0.13; I2 = 67%) between the two groups. Diabetes mellitus, chronic renal failure, previous PCI, and lactate level were found to be significant predictors of 30-day mortality on meta-regression (p < 0.05).
Conclusions:
This analysis shows that there is no significant difference in 30-day mortality, neurological status, or rate of PCI among patients with OHCA without ST-elevation treated with early versus nonearly CAG. Thirty-day mortality is determined by presentation comorbidities rather than revascularization.
Perspective:
Unlike OHCA with ST-segment elevation myocardial infarction, early CAG for patients without ST elevations and OHCA is not associated with improved survival or neurological recovery. Authors make a strong case for carefully selecting patients from this high-risk group who may benefit from CAG and more importantly to avoid delays in useful treatments like targeted temperature management. Multiple randomized clinical trials are ongoing to provide definitive guidance on which patients to consider for early CAG.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging, Chronic Angina
Keywords: Arrhythmias, Cardiac, Coronary Angiography, Diabetes Mellitus, Heart Arrest, Hypothermia, Induced, Kidney Failure, Chronic, Neurology, Out-of-Hospital Cardiac Arrest, Percutaneous Coronary Intervention, Renal Insufficiency, Chronic, Secondary Prevention, ST Elevation Myocardial Infarction
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