Author + information
- Received April 14, 2020
- Revision received July 9, 2020
- Accepted July 14, 2020
- Published online October 5, 2020.
- Beni R. Verma, MDa,
- Vikram Sharma, MDa,
- Shashank Shekhar, MDa,
- Manpreet Kaur, MDa,
- Shameer Khubber, MDa,
- Agam Bansal, MDa,
- Jarmanjeet Singh, MDa,
- Keerat Rai Ahuja, MDa,
- Salik Nazir, MDb,
- Michael Chetrit, MDa,
- Venu Menon, MDa,
- Grant Reed, MDa and
- Samir Kapadia, MDa,∗ ()
- aHeart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
- bDepartment of Cardiology, University of Toledo, Toledo, Ohio
- ↵∗Address for correspondence:
Dr. Samir Kapadia, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, Ohio 44195.
Objectives The authors conducted a meta-analysis to study clinical outcomes in patients who underwent early versus nonearly coronary angiography (CAG) in the setting of out-of-hospital cardiac arrest (OHCA) without ST-segment elevation.
Background The benefit of performing early CAG in patients with OHCA without STE remains disputed.
Methods MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from inception until February 21, 2020. Early and nonearly CAG patients were identified on the basis of the definitions mentioned in respective published studies. The primary outcome studied was 30-day mortality. Secondary outcomes were neurological status and the rate of percutaneous coronary intervention (PCI) following cardiac arrest.
Results Of 4,516 references, 11 studies enrolling 3,581 patients were included in the final meta-analysis. Random-effects analysis showed no differences in 30-day mortality (risk ratio [RR]: 0.86; 95% confidence interval [CI]: 0.71 to 1.04; p = 0.12; I2 = 74%), neurological status (RR: 1.08; 95% CI: 0.94 to 1.24; p = 0.28; I2 = 69%), and rate of PCI (RR: 1.22; 95% CI: 0.94 to 1.59; p = 0.13; I2 = 67%) between the 2 groups. Diabetes mellitus, chronic renal failure, previous PCI, and lactate level were found to be significant predictors of 30-day mortality on meta-regression (p < 0.05).
Conclusions This analysis shows that there is no significant difference in 30-day mortality, neurological status, or rate of PCI among patients with OHCA without STE treated with early versus nonearly CAG. Thirty-day mortality is determined by presentation comorbidities rather than revascularization.
- cardiac arrest
- coronary angiography
- out-of-hospital cardiac arrest without ST-segment elevation
- percutaneous coronary intervention
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received April 14, 2020.
- Revision received July 9, 2020.
- Accepted July 14, 2020.
- 2020 American College of Cardiology Foundation
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