Early Versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Kumait Al Lawati, MD; Ben Forestell, MD; Yasser Binbraik, MD; Sameer Sharif, MD; Craig Ainsworth, MD; Rebecca Mathew, MD; Faizan Amin, MD; Mohammed Al Fawaz, MD; Natalia Pinilla-Echeverri, MD; Emilie Belley-Côté, MD, PhD; Michelle Welsford, MD; Bram Rochwerg, MD, MSc

doi:10.1097/CCE.0000000000000874

Critical Care Explorations (Mar 2023)

Early Versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Kumait Al Lawati, MD,
Ben Forestell, MD,
Yasser Binbraik, MD,
Sameer Sharif, MD,
Craig Ainsworth, MD,
Rebecca Mathew, MD,
Faizan Amin, MD,
Mohammed Al Fawaz, MD,
Natalia Pinilla-Echeverri, MD,
Emilie Belley-Côté, MD, PhD,
Michelle Welsford, MD,
Bram Rochwerg, MD, MSc

Affiliations

Kumait Al Lawati, MD: 1 Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.
Ben Forestell, MD: 1 Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.
Yasser Binbraik, MD: 2 Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Sameer Sharif, MD: 1 Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.
Craig Ainsworth, MD: 2 Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Rebecca Mathew, MD: 6 Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Faizan Amin, MD: 2 Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Mohammed Al Fawaz, MD: 2 Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Natalia Pinilla-Echeverri, MD: 4 Department of Medicine, Division of Cardiology, McMaster University, Hamilton, ON, Canada.
Emilie Belley-Côté, MD, PhD: 2 Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Michelle Welsford, MD: 1 Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.
Bram Rochwerg, MD, MSc: 2 Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.

DOI: https://doi.org/10.1097/CCE.0000000000000874
Journal volume & issue: Vol. 5, no. 3
p. e0874

Abstract

Read online

OBJECTIVES:. The optimal timing of coronary angiography remains unclear following out-of-hospital cardiac arrest (OHCA) without ST elevation on electrocardiogram. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of early angiography versus delayed angiography following OHCA without ST elevation. DATA SOURCES:. The databases MEDLINE, PubMed EMBASE, and CINHAL, as well as unpublished sources from inception to March 9, 2022. STUDY SELECTION:. A systematic search was performed for randomized controlled trials of adult patients after OHCA without ST elevation who were randomized to early as compared to delayed angiography. DATA EXTRACTION:. Reviewers screened and abstracted data independently and in duplicate. The certainty of evidence was assessed for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach. The protocol was preregistered (CRD 42021292228). DATA SYNTHESIS:. Six trials were included (n = 1,590 patients). Early angiography probably has no effect on mortality (relative risk [RR] 1.04; 95% CI 0.94–1.15; moderate certainty) and may have no effect on survival with good neurologic outcome (RR 0.97; 95% CI 0.87–1.07; low certainty) or ICU length of stay (LOS) (mean difference 0.41 days fewer; 95% CI –1.3 to 0.5 d; low certainty). Early angiography has an uncertain effect on adverse events. CONCLUSIONS:. In OHCA patients without ST elevation, early angiography probably has no effect on mortality and may have no effect on survival with good neurologic outcome and ICU LOS. Early angiography has an uncertain effect on adverse events.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

About the journal