A-30 | Timing of Coronary Angiography for Patients Without ST-Segment Elevation After Cardiac Arrest

Abstract

Early coronary angiography (CAG) is recommended in patients with out of hospital cardiac arrest (OHCA) with ST segment elevation (STE) on electrocardiogram (ECG), but less is known about early CAG in OHCA patients without STE. This meta-analysis aims to evaluate the association between timing of CAG and outcomes in patients with OHCA without STE. We performed a literature search for studies reporting an association between timing of CAG and study endpoints. The primary endpoint was all-cause mortality. Secondary endpoints included neurological outcome and need for hemodialysis (HD). The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. We did not restrict to time or publication status. A total of 17 studies with 8118 participants (3447 with early CAG vs 4671 with late/no CAG) were included. Mean duration of follow-up was 138 days. Early CAG showed a trend towards reduction in all-cause mortality but this was not significant (OR 0.83, 95% CI 0.60-1.14; p=0.25) (Figure 1). There was no difference associated with neurologic outcome (OR 0.75, 95% CI 0.48-1.18; p=0.21) nor risk for HD (OR 1.0, 95% CI 0.73-1.38; p=0.99). Subgroup analysis by time to CAG demonstrated that early CAG was associated with increased all-cause mortality if performed immediately (OR 1.3, 95% CI 1.02-1.66; p=0.03), but decreased all-cause mortality if performed within 6 hours or within 24 hours (OR 0.73, 95% CI 0.58-0.90; p<0.01; OR 0.34, 95% CI 0.14-0.79; p=0.01). Early CAG in patients with OHCA without STE may be beneficial compared to late/no CAG if performed after initial patient stabilization.