Annals of medicine and surgery (2012) · 2025
Emergent coronary angiography in patients with out-of-hospital cardiac arrest: a systematic review and meta-analysis.
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Azhar Aima, Mazhar Saad, Khan Fasih Mand, Azhar Humera Raja, Zahra Syeda Wafa, Devi Deepa, Kumari Sapna, Nisha Fnu, Kumar Neha, Ejaz Umer, Rehman Saeed Ur, Jawad Sayed
Аннотация
BACKGROUND: Early coronary angiography (CAG) is a subject of controversy in post-cardiac arrest patients who do not exhibit ST-segment elevation. The objective of this meta-analysis was to evaluate the effect it had on outcomes.
METHODS: A comprehensive search of Medline and Cochrane yielded 16 studies [of which 9 were observational and 7 were randomized controlled trials (RCTs)] involving 4737 patients. 95% confidence intervals accompanied odds ratios (ORs) were generated by a random-effects model. Meta-regression explored factors modifying effect sizes.
RESULTS: Early coronary angiography (CAG) decreased long-term mortality significantly [OR: 0.66 (0.51-0.85)], improved favorable coronary prothrombotic scores [Cerebral Performance Category (CPC) 1-2] at discharge [OR: 1.49 (1.09-2.03)], and suggested a trend toward increased percutaneous coronary intervention after CAG [OR: 1.07 (0.75-1.53)]. In contrast to the RCT subgroup, the observational study subgroup exhibited reduced rates of short- and long-term mortality, as well as CPC1-2 at discharge. Meta-regression revealed that type 2 diabetes mellitus and follow-up time influence short-term mortality and CPC 1-2 at discharge, respectively.
CONCLUSION: Observational studies demonstrated that early CAG in post-cardiac arrest patients without ST elevation is associated with long-term clinical benefits. Caveat should be exercised when interpreting.
METHODS: A comprehensive search of Medline and Cochrane yielded 16 studies [of which 9 were observational and 7 were randomized controlled trials (RCTs)] involving 4737 patients. 95% confidence intervals accompanied odds ratios (ORs) were generated by a random-effects model. Meta-regression explored factors modifying effect sizes.
RESULTS: Early coronary angiography (CAG) decreased long-term mortality significantly [OR: 0.66 (0.51-0.85)], improved favorable coronary prothrombotic scores [Cerebral Performance Category (CPC) 1-2] at discharge [OR: 1.49 (1.09-2.03)], and suggested a trend toward increased percutaneous coronary intervention after CAG [OR: 1.07 (0.75-1.53)]. In contrast to the RCT subgroup, the observational study subgroup exhibited reduced rates of short- and long-term mortality, as well as CPC1-2 at discharge. Meta-regression revealed that type 2 diabetes mellitus and follow-up time influence short-term mortality and CPC 1-2 at discharge, respectively.
CONCLUSION: Observational studies demonstrated that early CAG in post-cardiac arrest patients without ST elevation is associated with long-term clinical benefits. Caveat should be exercised when interpreting.