Abstract 13539: The Effect of Emergency versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-segment Elevation: A Meta-Analysis of Randomized Clinical Trials

Abstract

Introduction. The prognosis of patients with out-of-hospital cardiac arrest (OHCA) is poor, with high mortality rates and poor neurological outcomes. Early coronary angiography (CAG) is recommended in patients with ST-segment elevation myocardial infarction (STEMI) associated with cardiac arrest; however, performing early or delayed CAG in patients with OHCA without STEMI is unclear. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the efficacy of early versus delayed CAG in patients with OHCA without STEMI. Methods. We searched Web of Science, SCOPUS, EMBASE, PubMed (MEDLINE), and CENTRAL from inception till June 2022. We included only RCTs that compared early versus delayed CAG in patients with OHCA. The main outcomes were percutaneous coronary intervention (PCI) rate, 30-day all-cause mortality, and neurological recovery (cerebral performance category (CPC) < 3). We used the fixed-effect model to pool the risk ratio (RR) with a 95% confidence interval (CI). Results. We included seven RCTs with a total of 2104 patients. The overall risk ratio showed no difference between early and delayed CAG regarding PCI rate (RR: 1.06 with 95% [0.92, 1.23] p= 0.43), 30 days mortality (RR: 1.08 with 95% CI [0.97, 1.20] p= 0.15, and neurological recovery (RR: 1.04 with 95% CI [0.95, 1.13] p= 0.4). Conclusion. Among patients who experience an OHCA without STEMI, a strategy of performing early CAG provided no benefits in respect to the rate of PCI, 30 days mortality, and neurological recovery compared to delayed CAG.