Outcomes With Early vs Nonearly Coronary Angiography for Out-of-Hospital Cardiac Arrest Without STE

Patients with out-of-hospital cardiac arrest (OHCA) without ST-segment elevation (STE) had comparable 30-day mortality, neurologic status, and rates of percutaneous coronary intervention (PCI) when treated with early vs nonearly coronary angiography (CAG), according to a study published in JACC: Cardiovascular Interventions.

In this systematic review and meta-analysis, 11 published studies in which outcomes of patients with OHCA without STE treated with early (n=1511) vs nonearly (n=2071) CAG were examined.

The definition of early and nonearly CAG varied across studies. In 45% of studies, early CAG was defined as an intervention occurring <2 hours after the event. In 18%, 9% and 18% of studies, CAG occurring within 6, 12, and 24 hours, respectively of OHCA was considered early CAG. Nonearly CAG was defined as CAG conducted beyond the early CAG cut-off values.

Early and nonearly CAG were found to be associated with comparable 30-day mortality (risk ratio [RR], 0.86; 95% CI, 0.71-1.04; P =.12), neurologic status (RR, 1.08; 95% CI, 0.94-1.24; P =.28), and rate of PCI (RR, 1.22; 95% CI, 0.94-1.59; P =.13). Significant predictors of 30-day mortality included diabetes mellitus, chronic renal failure, previous PCI, and lactate level (P <.05 for all).

Limitations of this study include the relatively short follow-up (30 days), the variability across studies in the definitions of early CAG, and the lack of data on CAG- or PCI-related complications.

 “[R]outine early CAG cannot be recommended in this population [of patients with OHCA],” noted the study authors.

Reference

Verma BR, Sharma V, Shekhar S, et al. Coronary angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation: A systematic review and meta-analysis. JACC Cardiovasc Interv. 2020;13(19):2193-2205. doi:10.1016/j.jcin.2020.07.018