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Resuscitation. 2017 Dec;121:127-134. doi: 10.1016/j.resuscitation.2017.10.019. Epub 2017 Oct 24.

Early coronary angiography in patients resuscitated from out of hospital cardiac arrest without ST-segment elevation: A systematic review and meta-analysis.

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Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, 1900 W Harrison Street, Chicago, IL, USA. Electronic address:
Department of Internal Medicine, Dow University of Health Sciences, Pakistan.
Cardiology Division, University of Louisville, KY, USA.
Heart and Vascular Institute, Cleveland Clinic, OH, USA.
University of British Columbia, Vancouver General Hospital, Canada.
Cardiology Division, Emory University, Atlanta, GA, USA.



A meta-analysis of published studies was performed to determine the impact of performing early versus delayed or no coronary angiography in patients without ST-segment elevation myocardial infarction following out of hospital cardiac arrest.


A structured search was conducted using Medline, Embase and Ovid by two independent investigators using a variety of keywords. The primary outcome was short term (at discharge) and long term (at 6-14 months follow-up) mortality whereas the secondary end-point was good neurological outcome (defined as a Cerebral Performance Category Score of 1 or 2), at discharge and follow up. Random-effects model was utilized to pool the data, whilst publication bias was assessed using funnel plot.


A total of 8 studies (7 observational studies and 1 randomized control trial) were identified and incorporated into the meta-analysis. The use of early angiography was associated with decreased short term (OR=0.46, 95% CI=0.36-0.56, P<0.001) and long term (OR=0.59, 95%CI=0.44-0.74, P<0.001) mortality. Early angiography was also shown to be associated with improved neurological outcomes on discharge (OR=2.00, 95% CI=1.50-2.49, P<0.001) as well as on follow-up (OR=1.48, 95% CI=1.06-1.90, P<0.001).


The results of our meta-analysis support the use of early coronary angiography in out of hospital cardiac-arrest patients presenting without ST-segment elevation on the post-resuscitation electrocardiogram. However, given the low level of evidence of available studies, future guideline changes should be directed by the results of large-scale randomized clinical trials on the subject matter.


Angiography; Early; NSTEMI; OHCA

[Indexed for MEDLINE]

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