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Review
. 2025 May 20;87(7):4373-4383.
doi: 10.1097/MS9.0000000000003290. eCollection 2025 Jul.

Emergent coronary angiography in patients with out-of-hospital cardiac arrest: a systematic review and meta-analysis

Aima Azhar  1 , Saad Mazhar  2 , Fasih Mand Khan  3 , Humera Raja Azhar  4 , Syeda Wafa Zahra  5 , Deepa Devi  6 , Sapna Kumari  6 , Fnu Nisha  7 , Neha Kumar  7 , Umer Ejaz  8 , Saeed Ur Rehman  9 , Sayed Jawad  10
Affiliations
Review

Emergent coronary angiography in patients with out-of-hospital cardiac arrest: a systematic review and meta-analysis

Aima Azhar et al. Ann Med Surg (Lond). .

Abstract

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.

Keywords: coronary angiography; myocardial infarction; non-ST elevation; out-of-hospital cardiac arrest.

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Conflict of interest statement

None to declare.

Figures

Figure 1.
Figure 1.
PRSIMA flowchart.
Figure 2.
Figure 2.
Funnel plot demonstrating publication bias for the outcome of short-term mortality.
Figure 3.
Figure 3.
Forest plot comparing the effect of early CAG and delayed or no CAG on short-term mortality among NSTE-OHCA patients in RCTs and observational studies.
Figure 4.
Figure 4.
Forest plot comparing the effect of early CAG and delayed or no CAG on short-term mortality among NSTE-OHCA patients in RCTs and observational studies..
Figure 5.
Figure 5.
Forest plot comparing the effect of early CAG and delayed or no CAG on the incidence of CPC 1–2 scores at follow-up among NSTE-OHCA patients in RCT and observational studies.
Figure 6.
Figure 6.
Forest plot comparing the effect of early CAG and delayed or no CAG on the incidence of CPC 1–2 scores at follow-up among NSTE-OHCA patients in RCT and observational studies.
Figure 7.
Figure 7.
Forest plot comparing the effect on the occurrence of PCI after early CAG and delayed or no CAG among NSTE-OHCA patients in RCTs and observational studies.
Figure 8.
Figure 8.
Funnel plot demonstrating publication bias for the outcome of successful PCI after CAG.
See this image and copyright information in PMC

References

    1. Brooks SC, Clegg GR, Bray J, et al. Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: a scientific statement from the International Liaison Committee on Resuscitation. Circulation 2022;145:E776–E801. - PubMed
    1. Latest Statistics: 1,000 People Suffer Sudden Cardiac Arrest Each Day in U.S.; Only 10% Survive|Sudden Cardiac Arrest Foundation. Accessed3 January 2024. https://www.sca-aware.org/scanews/latest-statistics-1000-people-suffer-s...
    1. Quest TE, Lu DW. Ethics of resuscitation. In: Emergency Medicine: Clinical Essentials, 2nd edn. 2012, 1770–1773.e1. doi: 10.1016/B978-1-4377-3548-2.00214-7 - DOI
    1. Kumar S, Abdelghaffar B, Iyer M, et al. Coronary angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation on electrocardiograms: a comprehensive review. JSCAI 2023;2:100536. - PMC - PubMed
    1. Pt O, Fg K, Dd A, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation 2013;127:529–55. - PubMed

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