Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation : a systematic review and meta-analysis of randomized controlled trials
© 2023. The Author(s)..
BACKGROUND: Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear.
METHODS: We included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects.
RESULTS: In total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91-1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89-1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00-2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82-1.33, P = 0.74; P-interaction 0.097).
CONCLUSION: In OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:113 |
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| Enthalten in: |
Clinical research in cardiology : official journal of the German Cardiac Society - 113(2024), 4 vom: 25. März, Seite 561-569 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hamidi, Fardin [VerfasserIn] |
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| Links: |
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| Themen: |
Coronary angiography |
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| Anmerkungen: |
Date Completed 21.03.2024 Date Revised 23.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00392-023-02264-7 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM359958060 |
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| 100 | 1 | |a Hamidi, Fardin |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation |b a systematic review and meta-analysis of randomized controlled trials |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Completed 21.03.2024 | ||
| 500 | |a Date Revised 23.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a BACKGROUND: Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear | ||
| 520 | |a METHODS: We included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects | ||
| 520 | |a RESULTS: In total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91-1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89-1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00-2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82-1.33, P = 0.74; P-interaction 0.097) | ||
| 520 | |a CONCLUSION: In OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Coronary angiography | |
| 650 | 4 | |a Critical care medicine | |
| 650 | 4 | |a Out-of-hospital cardiac arrest | |
| 650 | 4 | |a Percutaneous coronary intervention | |
| 700 | 1 | |a Anwari, Elaaha |e verfasserin |4 aut | |
| 700 | 1 | |a Spaulding, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Hauw-Berlemont, Caroline |e verfasserin |4 aut | |
| 700 | 1 | |a Vilfaillot, Aurélie |e verfasserin |4 aut | |
| 700 | 1 | |a Viana-Tejedor, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Kern, Karl B |e verfasserin |4 aut | |
| 700 | 1 | |a Hsu, Chiu-Hsieh |e verfasserin |4 aut | |
| 700 | 1 | |a Bergmark, Brian A |e verfasserin |4 aut | |
| 700 | 1 | |a Qamar, Arman |e verfasserin |4 aut | |
| 700 | 1 | |a Bhatt, Deepak L |e verfasserin |4 aut | |
| 700 | 1 | |a Furtado, Remo H M |e verfasserin |4 aut | |
| 700 | 1 | |a Myhre, Peder L |e verfasserin |4 aut | |
| 700 | 1 | |a Hengstenberg, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Lang, Irene M |e verfasserin |4 aut | |
| 700 | 1 | |a Frey, Norbert |e verfasserin |4 aut | |
| 700 | 1 | |a Freund, Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Desch, Steffen |e verfasserin |4 aut | |
| 700 | 1 | |a Thiele, Holger |e verfasserin |4 aut | |
| 700 | 1 | |a Preusch, Michael R |e verfasserin |4 aut | |
| 700 | 1 | |a Zelniker, Thomas A |e verfasserin |4 aut | |
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