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

Khan, Muhammad Shahzeb; Shah, Sharaf Ali; Mubashir, Ayesha; Khan, Abdur Rahman; Fatima, Kaneez; Schenone, Aldo L.; Khosa, Faisal; Samady, Habib; Menon, Venu

doi:10.1016/j.resuscitation.2017.10.019

Cited by 52 publications

(40 citation statements)

References 31 publications

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“…As to the primary endpoints, our analysis did show a hospital discharged survival and long-term survival bene ts with early CAG for NSTE OHCA when analyzed by the subgroup of observational studies and overall groups. Consistently, two reviews [6,9] and some observational studies [10][11][12] support the result of the present analysis. Vadeboncoeur et al [10] conducted a study including 1230 cases NSTE OHCA, the survival to hospital discharge was 78.3% for those without CAG and 81.5% for those who underwent CAG (p < 0.0001).…”

Section: Discussionsupporting

confidence: 91%

“…Vadeboncoeur et al [10] conducted a study including 1230 cases NSTE OHCA, the survival to hospital discharge was 78.3% for those without CAG and 81.5% for those who underwent CAG (p < 0.0001). A recent meta-analysis [9] of 8 studies reported that the strategy of early CAG 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. Hollenbeck et al [11] found that patients treated with CAG were more likely to receive mechanical support and were also treated with more aggressive anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…Two reviews conducted in 2016 and 2017 respectively support the use of early CAG in OHCA patients presenting NSTE [6,7]. However, Lemkes et al [8] published an article indicated that, immediate angiography was not found to be better than delayed angiography with respect to overall survival at 90 days for patients who had been successfully resuscitated after OHCA and had no signs of STEMI [8].…”

Section: Introductionmentioning

confidence: 99%

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Early coronary angiography and percutaneous coronary intervention for out of hospital cardiac arrest survivors without ST-segment elevation: a systematic review and meta-analysis

Huang¹,

Liu²,

Guo

et al. 2020

Preprint

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Objective: The meta-analysis aims to identify whether out of hospital cardiac arrest (OHCA) survivors of non ST-segment elevation (NSTE) can benefit from early coronary angiography (CAG) and percutaneous coronary intervention (PCI).Methods: The relevant studies from MEDLINE, Cochrane Library, Embase were searched by two independent investigators using a variety of keywords. Stata software (version 12.0, Stata Corp LP, College Station, TX, USA) was used for statistical analysis. Results: A total of 12 studies (9 observational studies, 1 cohort study and 2 randomized control trials) were identified and incorporated into the meta-analysis. For overall analysis, the strategy of early angiography was associated with decreased short-term (hospital discharged) mortality (RR=0.72, 95% CI=0.56-0.93, P=0.000) and long-term (follow up) mortality (RR=0.84, 95% CI=0.71-0.99, P=0.007). However, when analyzed in the subgroup of randomized controlled study, the strategy of early angiography didn’t have survival benefit in the randomized controlled study group for short-term mortality (RR=1.12, 95% CI=0.89-1.41, P=0.331) and long-term mortality (RR=1.06, 95% CI=0.85-1.32, P=0.572). Meanwhile, our analysis found that, if early CAG performed, PCI followed by CAG is not associated with hospital discharged mortality (RR=1.14, 95% CI=0.96-1.37, P=0.132) compared with CAG alone. No significant differences between the groups were found in the remaining secondary endpoints.Conclusion: Due to the observational nature of the studies available, we may consider that early CAG and PCI is not be recommended for patients with NSTE OHCA.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early coronary angiography and percutaneous coronary intervention for out of hospital cardiac arrest survivors without ST-segment elevation: a systematic review and meta-analysis

Huang¹,

Liu²,

Guo

et al. 2020

Preprint

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“…Callaway and his college demonstrated in a multicenter study between 2007 and 2009 with 3,981 patients that early coronary angiography was an independent predictor for survival and favorable outcome. More recently Khan et al showed in a meta‐analysis of eight studies (seven observational studies and one randomized study) that the use of coronary angiography was associated with decreased short‐term (OR 0.46; 95%CI 0.36–0.56, p < .001) and long‐term (OR 0.59; 95%CI 0.44–0.74, p < .001) mortality. Predictors of in‐hospital mortality in our study were older age, metabolic derangement on admission, initial nonshockable rhythm and failure to achieve ROSC before admission.…”

Section: Discussionmentioning

confidence: 99%

Outcome predictors of patients with out of hospital cardiac arrest and immediate coronary angiography

Almalla

Kersten

Altiok

et al. 2019

Cathet Cardio Intervent

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Background Out of hospital cardiac arrest (OHCA) is common and associated with low survival rates. Guidelines propose a fast work‐up after OHCA including coronary angiography (CA) but little is known about the actual outcome of those patients who undergo immediate CA after OHCA with suspected cardiac origin. Aim The aim of this retrospective single‐center study was to evaluate the short‐term outcomes and predictors of in‐hospital mortality in patients who underwent immediate CA after OHCA with suspected cardiac origin. Methods We included all consecutive patients with OHCA who underwent immediate CA between January 2011 and December 2015. We defined immediate CA after OHCA as angiography within 2 hr after admission. Results Two hundred and nineteen consecutive patients with OHCA were included. Fifty six patients (26%) underwent CA without previous return of spontaneous circulation (ROSC) and with ongoing CPR using the LUCAS‐device. One hundred and forty nine patients (67%) died in hospital. Of the 56 patients with CA with ongoing CPR, 55 died and only 1 patient survived to hospital discharge. In a multivariate analysis, older age (OR = 2.03, 95%CI 1.35–3.03; p = .001), initial shockable rhythm (OR = 0.28, 95%CI 0.07–1.13; p = .076), CA with ongoing CPR (OR = 11.63, 95%CI 1.20–122.55; p = .035), and initial arterial pH (OR = 0.008, 95%CI 0.00–0.228; p < .005) remained as independent predictors for in‐hospital mortality. Conclusions In this study older age, metabolic derangement on admission, initial nonshockable rhythm and failure to achieve ROSC before admission predicted in‐hospital mortality. While CA with ongoing CPR with the LUCAS‐device was feasible, mortality in patients without previous ROSC was extremely high, questioning whether this approach is medically useful.

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“…Another meta-analysis, conducted in 2012, compared CAG and PCI with conventional treatment (late/no CAG) in patients with and without ST elevation and revealed improvement in survival with early CAG (OR = 2.78; 95%CI = 1.89–4.10; P < .001 in 10 studies with 3103 patients). [ 24 ] A meta-analysis by Khan et al [ 27 ] that included eight studies, with some published as recently as 2017, compared acute CAG with non-acute CAG in patients without ST elevation followed OHCA. The study concluded that early CAG was associated with decreased short-term mortality (OR = 0.46; 95%CI = 0.36–0.56; P < .001, with 2133 patients).…”

Section: Discussionmentioning

confidence: 99%

Coronary angiography or not after cardiac arrest without ST segment elevation

Yang

et al. 2020

Medicine

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Objective: This meta-analysis aimed to review the available evidence and evaluate the necessity of immediate coronary angiography (CAG) to obtain positive outcomes for out-of-hospital cardiac arrest (OHCA) patients without ST segment elevation. Data sources: Web of Science, PubMed, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed databases. Study selection: We included observational and case–control studies of outcomes among individuals without ST segment elevation experiencing OHCA who had immediate, delayed, or no CAG. Data extraction: We extracted study details, as well as patient characteristics and outcomes. Data synthesis: Six studies (n = 2665) investigating mortality until discharge demonstrated a significant increase in survival benefit with early CAG (odds ratio [OR] = 1.78; 95%CI = 1.51–2.11; I 2 = 81%; P < .0001). Seven studies (n = 2909) showed a significant preservation of neurological functions with early CAG at discharge (OR = 1.66; 95%CI = 1.37–2.02; P < .00001). Four studies (n = 1357) investigating survival outcomes with middle-term follow-up revealed no significant benefit with early CAG (OR = 1.21; 95%CI = 0.93–1.57; I 2 = 66%; P = .15). Conclusions: Our meta-analysis demonstrates that there may be significant benefits in performing immediate CAG on patients who experience OHCA without ST segment elevation.

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

Cited by 52 publications

References 31 publications

Early coronary angiography and percutaneous coronary intervention for out of hospital cardiac arrest survivors without ST-segment elevation: a systematic review and meta-analysis

Early coronary angiography and percutaneous coronary intervention for out of hospital cardiac arrest survivors without ST-segment elevation: a systematic review and meta-analysis

Outcome predictors of patients with out of hospital cardiac arrest and immediate coronary angiography

Coronary angiography or not after cardiac arrest without ST segment elevation

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