TY - JOUR
T1 - Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation
T2 - a systematic review and meta-analysis of randomized controlled trials
AU - Hamidi, Fardin
AU - Anwari, Elaaha
AU - Spaulding, Christian
AU - Hauw-Berlemont, Caroline
AU - Vilfaillot, Aurélie
AU - Viana-Tejedor, Ana
AU - Kern, Karl B.
AU - Hsu, Chiu Hsieh
AU - Bergmark, Brian A.
AU - Qamar, Arman
AU - Bhatt, Deepak L.
AU - Furtado, Remo H.M.
AU - Myhre, Peder L.
AU - Hengstenberg, Christian
AU - Lang, Irene M.
AU - Frey, Norbert
AU - Freund, Anne
AU - Desch, Steffen
AU - Thiele, Holger
AU - Preusch, Michael R.
AU - Zelniker, Thomas A.
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2024/4
Y1 - 2024/4
N2 - 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. Graphical abstract: (Figure presented.)
AB - 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. Graphical abstract: (Figure presented.)
KW - Coronary angiography
KW - Critical care medicine
KW - Out-of-hospital cardiac arrest
KW - Percutaneous coronary intervention
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U2 - 10.1007/s00392-023-02264-7
DO - 10.1007/s00392-023-02264-7
M3 - Article
C2 - 37495798
AN - SCOPUS:85165625781
SN - 1861-0684
VL - 113
SP - 561
EP - 569
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
IS - 4
ER -