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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.

Author information

1
Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, 1900 W Harrison Street, Chicago, IL, USA. Electronic address: PakistanShahzebkhan@gmail.com.
2
Department of Internal Medicine, Dow University of Health Sciences, Pakistan.
3
Cardiology Division, University of Louisville, KY, USA.
4
Heart and Vascular Institute, Cleveland Clinic, OH, USA.
5
University of British Columbia, Vancouver General Hospital, Canada.
6
Cardiology Division, Emory University, Atlanta, GA, USA.

Abstract

OBJECTIVE:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

KEYWORDS:

Angiography; Early; NSTEMI; OHCA

[Indexed for MEDLINE]

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