A-2 | Early vs. Non-Early Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: Meta-Analysis of Observational Studies and Randomized Controlled Trials

Abstract

Although immediate coronary angiography (CAG) and revascularization is recommended in patients with out-of-hospital cardiac arrest (OHCA) with ST-segment elevation (STE) on electrocardiography to reduce mortality, the benefit of early CAG in patients with OHCA without STE still remains disputed in the current literature. We aimed to determine the value of early vs non-early CAG in patients with OHCA without STE. An electronic search was performed using PubMed, EMBASE, Ovid Medline, and Cochrane Database from inception to September 2022. References were searched manually. Early and nonearly CAG patients were identified based on the definitions mentioned in respective published studies. Outcomes of interest included early (0–3 months) mortality, mid-term (6-12 months) mortality, rates of percutaneous coronary intervention (PCI), and neurological status (cerebral performance category score 1 or 2). Mantel-Haenszel aggregated risk ratios (RR) with 95% confidence intervals (CIs) were calculated. A total of 16 studies (8 randomized control trials (RCT) and 8 observational studies) were included in our final analysis. Together these included 2,228 patients receiving early CAG vs 3,005 patients receiving non-early CAG. While, on a pooled analysis, patients receiving early CAG had significantly lower early mortality (RR: 0.86; CI: 0.76 to 0.98; I2: 67%, p=0.02) and mid-term mortality (RR: 0.88; CI: 0.80 to 0.96; I2: 30%, p<0.01) compared to those receiving non-early CAG, RCT only analysis demonstrated that there was no difference in the early mortality (RR: 0.94; CI: 0.86 to 1.03; I2: 0%, p=0.19) or mid-term mortality (RR: 0.95; CI: 0.87 to 1.03; I2: 0%, p=0.22) between both the cohorts. There was no significant difference in the rates of PCI (RR: 1.27; CI: 0.96 to 0.70; I2: 89%, p=0.10) or neurological status between both the cohorts (RR: 1.05; CI: 0.93 to 1.18; I2: 51%, p=0.46) in the pooled analysis. In our pooled analysis, patients admitted with OHCA without STE, who received early CAG had better early as well as mid-term mortality compared to those receiving non-early CAG. RCT-only analysis failed to demonstrate any significant difference in the early or mid-term mortality between both cohorts.