Iranian Heart Journal

Iranian Heart Journal

Early vs Delayed Coronary Angiography in Out-of-Hospital Cardiac Arrest Patients Without ST-Segment Elevation: An Updated Meta-Analysis of Randomized Controlled Trials

Document Type : Original Article

Authors
Sahib Singh 1
Sanchit Duhan 1
Amit Rout 2
Aakash Garg 3
Sohail Ikram 2
1 Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA.
2 Division of Cardiology, University of Louisville, Kentucky, USA.
3 Division of Cardiology, Ellis Hospital, NY, USA.
Abstract
Background: The routine practice of early coronary angiography in patients who have suffered an out-of-hospital cardiac arrest without ST-segment elevation remains a subject of controversy.
 
Methods: We searched electronic databases for randomized controlled trials that compared early or emergency coronary angiography with delayed or no coronary angiography in patients who had an out-of-hospital cardiac arrest without ST-segment elevation. A random-effects meta-analysis was performed to estimate the odds ratio (OR) with a 95% confidence interval (CI). The outcomes of interest were mortality and neurological prognosis, based on the cerebral performance categories (CPC 1–2) scale.
 
Results: Seven studies involving 1623 patients (the early group [n=816] and the delayed group [n=807]) were included in the final analysis. Compared to delayed coronary angiography, early coronary angiography was associated with similar odds of mortality (OR, 1.07; 95% CI, 0.87 to 1.31; P=0.52) and a favorable neurological prognosis (OR, 0.97; 95% CI, 0.78 to 1.19; P=0.74).
 
Conclusions: For patients with an out-of-hospital cardiac arrest without ST-segment elevation, there was no benefit concerning mortality and neurological prognosis with early coronary angiography compared with delayed coronary angiography. (Iranian Heart Journal 2024; 25(2): 26-34)
Keywords
Early coronary angiography
Delayed coronary angiography
Out-of-hospital cardiac arrest
Non–ST-elevation myocardial infarction
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Iranian Heart Journal
Volume 25, Issue 2
Spring 2024
Pages 26-34