Abstract
Background/Aim: Although early coronary angiography (CAG) is currently recommended in patients with out of hospital cardiac arrest (OHCA) with ST segment elevation on electrocardiogram (EKG), the benefits in OHCA patients without ST segment elevation is unclear. The purpose of this meta-analysis is to evaluate the association between timing of CAG and clinical outcomes in patients with OHCA without ST segment elevation on EKG. Methods: We performed a literature search for studies reporting an association between timing of CAG and study endpoints. The primary endpoint was all-cause mortality. The secondary endpoints neurological outcome and need for dialysis. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results: A total of 17 studies with 8118 participants (3447 with early CAG vs 4671 with late/no CAG) were included. The mean duration of follow-up was 138 days. Early CAG showed a trend toward reduction in all-cause mortality but this was not statistically significant (OR 0.83, 95% CI 0.60-1.14; p=0.25). Early CAG showed a trend toward favorable neurological outcome but this was not statistically significant (OR 0.75, 95% CI 0.48-1.18; p=0.21. Early CAG was not associated with increased risk for acute renal failure requiring hemodialysis (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). Conclusions: Early CAG in patients presenting after OHCA without ST segment elevation may be beneficial compared to late/no CAG if performed after initial patient stabilization.
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