Author + information
- Paul A. Gurbel,
- Rahul Chaudhary,
- Kevin Bliden,
- Harleen Dehal and
- Udaya Tantry
Introduction: A mortality benefit of early coronary angiography (ECA) in patients with out-of-hospital cardiac arrest (OHCA) and ST-elevation myocardial infarction (STEMI) is well-established. However, the benefit of ECA in patients with OHCA not meeting the criteria for STEMI is still uncertain. We sought to determine the effect in all-cause mortality and neurological recovery of ECA in patients with OHCA not meeting criteria for STEMI.
Methods: We performed electronic searches on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases from the inception through October 19, 2016 to identify clinical trials evaluating the role of ECA in OHCA patients without STEMI. Neurological outcomes were assessed using cerebral performance category (CPC) score, with score 5 or brain death, CPC scores 1 to 2 showing good neurological recovery. Odds ratio (OR) and 95% confidence intervals (CI) were measured using random effects model.
Results: We analyzed a total of 1,460 patients (582 in the ECA and 878 in late or no coronary angiography) enrolled in 4 clinical trials (1 randomized controlled trial [RCTs], 2 prospective cohort and 1 retrospective study). The mean age was 61.5 years and mean follow-up period was 262 days. There was a significant reduction in all-cause mortality with ECA versus late or no coronary angiography at the time of hospital discharge and at follow-up (OR 0.41, 95% CI 0.31 – 0.55; I2=0% and OR 0.63, 95% CI 0.43 to 0.93; I2=38% respectively). Additionally, a significant improvement in CPC score 1-2 was observed with ECA both, at the time of hospital discharge and at longest follow-up (OR 1.72, 95% CI 1.16 – 2.54; I2=0% and OR 1.63, 95% CI 1.20 – 2.22; I2=15% respectively). No significant publication bias was observed in the results.
Conclusions: Our analysis demonstrates that early coronary angiography in OHCA patients without STEMI is associated with a significant and sustained reduction in all-cause mortality and improvement in neurological recovery
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1204-316
- 2017 American College of Cardiology Foundation