Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials
Background Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high...
Gespeichert in:
| Veröffentlicht in: | Clinical research in cardiology 2024-04, Vol.113 (4), p.561-569 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 569 |
|---|---|
| container_issue | 4 |
| container_start_page | 561 |
| container_title | Clinical research in cardiology |
| container_volume | 113 |
| creator | Hamidi, Fardin Anwari, Elaaha Spaulding, Christian Hauw-Berlemont, Caroline Vilfaillot, Aurélie Viana-Tejedor, Ana Kern, Karl B. Hsu, Chiu-Hsieh Bergmark, Brian A. Qamar, Arman Bhatt, Deepak L. Furtado, Remo H. M. Myhre, Peder L. Hengstenberg, Christian Lang, Irene M. Frey, Norbert Freund, Anne Desch, Steffen Thiele, Holger Preusch, Michael R. Zelniker, Thomas A. |
| description | Background
Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear.
Methods
We included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects.
Results
In total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91–1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89–1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00–2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82–1.33, P = 0.74; P-interaction 0.097).
Conclusion
In OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG.
Graphical abstract |
| doi_str_mv | 10.1007/s00392-023-02264-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10954865</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2843034177</sourcerecordid><originalsourceid>FETCH-LOGICAL-c500t-90e397b5e8e474e66b9e7b76a26d2dcf8cedc575e8324d5027b9e9717a63539c3</originalsourceid><addsrcrecordid>eNp9kstu1DAUhiMEoqXwAiyQJTZsAo6dxDEbhKpykSqxoKwtj3OSceXYg-1MlT5bH44zM-1wWbCIb-c7_7FP_qJ4WdG3FaXiXaKUS1ZSxvFjbV2KR8Vp1bVVSVvJHh_XXX1SPEvpmtKmorx-WpxwUctGyO60uLvQ0S1kCzHNifTg9AI9MSEGr-NCtB9tGKPerBdiPdnobMHnRG5sXpMw5zIM5Tqkjc3aEaNjb7UhOkZIGXN74gP5flUmGCdMI-BgiwrBvyeapCVlmHBrSISthZt9wgRZl9prtySbSBhIxNMw2dv9rXyOwTlc5mi1S8-LJwNO8OJ-Pit-fLq4Ov9SXn77_PX842VpGkpzKSlwKVYNdFCLGtp2JUGsRKtZ27PeDJ2B3jQC45zVfUOZQECKSuiWN1waflZ8OOhu5tWELL4laqc20U7YJBW0VX9HvF2rMWxVRWVTd22DCuSgYKJN2XrlQ9QY7hqGo5Byh7y5LxLDzxkbqCabDDinPYQ5KdbVHP9eJQSir_9Br8McsWlIyVZWteCsQ4o91AwpRRiOF66o2hlIHQyk0EBqbyC1k37151OPKQ-OQYAfgIQhP0L8Xfs_sr8Arr3VEw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2969147328</pqid></control><display><type>article</type><title>Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials</title><source>MEDLINE</source><source>NORA - Norwegian Open Research Archives</source><source>Springer Nature - Complete Springer Journals</source><creator>Hamidi, Fardin ; Anwari, Elaaha ; Spaulding, Christian ; Hauw-Berlemont, Caroline ; Vilfaillot, Aurélie ; Viana-Tejedor, Ana ; Kern, Karl B. ; Hsu, Chiu-Hsieh ; Bergmark, Brian A. ; Qamar, Arman ; Bhatt, Deepak L. ; Furtado, Remo H. M. ; Myhre, Peder L. ; Hengstenberg, Christian ; Lang, Irene M. ; Frey, Norbert ; Freund, Anne ; Desch, Steffen ; Thiele, Holger ; Preusch, Michael R. ; Zelniker, Thomas A.</creator><creatorcontrib>Hamidi, Fardin ; Anwari, Elaaha ; Spaulding, Christian ; Hauw-Berlemont, Caroline ; Vilfaillot, Aurélie ; Viana-Tejedor, Ana ; Kern, Karl B. ; Hsu, Chiu-Hsieh ; Bergmark, Brian A. ; Qamar, Arman ; Bhatt, Deepak L. ; Furtado, Remo H. M. ; Myhre, Peder L. ; Hengstenberg, Christian ; Lang, Irene M. ; Frey, Norbert ; Freund, Anne ; Desch, Steffen ; Thiele, Holger ; Preusch, Michael R. ; Zelniker, Thomas A.</creatorcontrib><description>Background
Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear.
Methods
We included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects.
Results
In total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91–1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89–1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00–2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82–1.33, P = 0.74; P-interaction 0.097).
Conclusion
In OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG.
Graphical abstract</description><identifier>ISSN: 1861-0684</identifier><identifier>ISSN: 1861-0692</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-023-02264-7</identifier><identifier>PMID: 37495798</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Angiography ; Cardiac arrest ; Cardiology ; Cardiopulmonary Resuscitation ; Cardiovascular disease ; Clinical trials ; Coronary Angiography - adverse effects ; Coronary artery disease ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnostic imaging ; Coronary vessels ; Death ; Female ; Heterogeneity ; Hospitals ; Humans ; Ischemia ; Male ; Medical imaging ; Medicine ; Medicine & Public Health ; Meta-analysis ; Mortality ; Myocardial infarction ; Original Paper ; Out-of-Hospital Cardiac Arrest - diagnostic imaging ; Out-of-Hospital Cardiac Arrest - therapy ; Patients ; Percutaneous Coronary Intervention - adverse effects ; Randomized Controlled Trials as Topic ; Segments ; Statistical analysis ; Subgroups ; Trinucleotide repeats ; Vein & artery diseases ; Women</subject><ispartof>Clinical research in cardiology, 2024-04, Vol.113 (4), p.561-569</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>info:eu-repo/semantics/openAccess</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c500t-90e397b5e8e474e66b9e7b76a26d2dcf8cedc575e8324d5027b9e9717a63539c3</citedby><cites>FETCH-LOGICAL-c500t-90e397b5e8e474e66b9e7b76a26d2dcf8cedc575e8324d5027b9e9717a63539c3</cites><orcidid>0000-0001-7737-3479 ; 0000-0002-6444-8598 ; 0000-0003-0485-2692 ; 0000-0002-8284-2994 ; 0000-0001-9492-6688</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00392-023-02264-7$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00392-023-02264-7$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,26544,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37495798$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hamidi, Fardin</creatorcontrib><creatorcontrib>Anwari, Elaaha</creatorcontrib><creatorcontrib>Spaulding, Christian</creatorcontrib><creatorcontrib>Hauw-Berlemont, Caroline</creatorcontrib><creatorcontrib>Vilfaillot, Aurélie</creatorcontrib><creatorcontrib>Viana-Tejedor, Ana</creatorcontrib><creatorcontrib>Kern, Karl B.</creatorcontrib><creatorcontrib>Hsu, Chiu-Hsieh</creatorcontrib><creatorcontrib>Bergmark, Brian A.</creatorcontrib><creatorcontrib>Qamar, Arman</creatorcontrib><creatorcontrib>Bhatt, Deepak L.</creatorcontrib><creatorcontrib>Furtado, Remo H. M.</creatorcontrib><creatorcontrib>Myhre, Peder L.</creatorcontrib><creatorcontrib>Hengstenberg, Christian</creatorcontrib><creatorcontrib>Lang, Irene M.</creatorcontrib><creatorcontrib>Frey, Norbert</creatorcontrib><creatorcontrib>Freund, Anne</creatorcontrib><creatorcontrib>Desch, Steffen</creatorcontrib><creatorcontrib>Thiele, Holger</creatorcontrib><creatorcontrib>Preusch, Michael R.</creatorcontrib><creatorcontrib>Zelniker, Thomas A.</creatorcontrib><title>Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><addtitle>Clin Res Cardiol</addtitle><description>Background
Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear.
Methods
We included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects.
Results
In total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91–1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89–1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00–2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82–1.33, P = 0.74; P-interaction 0.097).
Conclusion
In OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG.
Graphical abstract</description><subject>Angiography</subject><subject>Cardiac arrest</subject><subject>Cardiology</subject><subject>Cardiopulmonary Resuscitation</subject><subject>Cardiovascular disease</subject><subject>Clinical trials</subject><subject>Coronary Angiography - adverse effects</subject><subject>Coronary artery disease</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary vessels</subject><subject>Death</subject><subject>Female</subject><subject>Heterogeneity</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Original Paper</subject><subject>Out-of-Hospital Cardiac Arrest - diagnostic imaging</subject><subject>Out-of-Hospital Cardiac Arrest - therapy</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Segments</subject><subject>Statistical analysis</subject><subject>Subgroups</subject><subject>Trinucleotide repeats</subject><subject>Vein & artery diseases</subject><subject>Women</subject><issn>1861-0684</issn><issn>1861-0692</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>3HK</sourceid><recordid>eNp9kstu1DAUhiMEoqXwAiyQJTZsAo6dxDEbhKpykSqxoKwtj3OSceXYg-1MlT5bH44zM-1wWbCIb-c7_7FP_qJ4WdG3FaXiXaKUS1ZSxvFjbV2KR8Vp1bVVSVvJHh_XXX1SPEvpmtKmorx-WpxwUctGyO60uLvQ0S1kCzHNifTg9AI9MSEGr-NCtB9tGKPerBdiPdnobMHnRG5sXpMw5zIM5Tqkjc3aEaNjb7UhOkZIGXN74gP5flUmGCdMI-BgiwrBvyeapCVlmHBrSISthZt9wgRZl9prtySbSBhIxNMw2dv9rXyOwTlc5mi1S8-LJwNO8OJ-Pit-fLq4Ov9SXn77_PX842VpGkpzKSlwKVYNdFCLGtp2JUGsRKtZ27PeDJ2B3jQC45zVfUOZQECKSuiWN1waflZ8OOhu5tWELL4laqc20U7YJBW0VX9HvF2rMWxVRWVTd22DCuSgYKJN2XrlQ9QY7hqGo5Byh7y5LxLDzxkbqCabDDinPYQ5KdbVHP9eJQSir_9Br8McsWlIyVZWteCsQ4o91AwpRRiOF66o2hlIHQyk0EBqbyC1k37151OPKQ-OQYAfgIQhP0L8Xfs_sr8Arr3VEw</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Hamidi, Fardin</creator><creator>Anwari, Elaaha</creator><creator>Spaulding, Christian</creator><creator>Hauw-Berlemont, Caroline</creator><creator>Vilfaillot, Aurélie</creator><creator>Viana-Tejedor, Ana</creator><creator>Kern, Karl B.</creator><creator>Hsu, Chiu-Hsieh</creator><creator>Bergmark, Brian A.</creator><creator>Qamar, Arman</creator><creator>Bhatt, Deepak L.</creator><creator>Furtado, Remo H. M.</creator><creator>Myhre, Peder L.</creator><creator>Hengstenberg, Christian</creator><creator>Lang, Irene M.</creator><creator>Frey, Norbert</creator><creator>Freund, Anne</creator><creator>Desch, Steffen</creator><creator>Thiele, Holger</creator><creator>Preusch, Michael R.</creator><creator>Zelniker, Thomas A.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>P64</scope><scope>7X8</scope><scope>3HK</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7737-3479</orcidid><orcidid>https://orcid.org/0000-0002-6444-8598</orcidid><orcidid>https://orcid.org/0000-0003-0485-2692</orcidid><orcidid>https://orcid.org/0000-0002-8284-2994</orcidid><orcidid>https://orcid.org/0000-0001-9492-6688</orcidid></search><sort><creationdate>20240401</creationdate><title>Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials</title><author>Hamidi, Fardin ; Anwari, Elaaha ; Spaulding, Christian ; Hauw-Berlemont, Caroline ; Vilfaillot, Aurélie ; Viana-Tejedor, Ana ; Kern, Karl B. ; Hsu, Chiu-Hsieh ; Bergmark, Brian A. ; Qamar, Arman ; Bhatt, Deepak L. ; Furtado, Remo H. M. ; Myhre, Peder L. ; Hengstenberg, Christian ; Lang, Irene M. ; Frey, Norbert ; Freund, Anne ; Desch, Steffen ; Thiele, Holger ; Preusch, Michael R. ; Zelniker, Thomas A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c500t-90e397b5e8e474e66b9e7b76a26d2dcf8cedc575e8324d5027b9e9717a63539c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Angiography</topic><topic>Cardiac arrest</topic><topic>Cardiology</topic><topic>Cardiopulmonary Resuscitation</topic><topic>Cardiovascular disease</topic><topic>Clinical trials</topic><topic>Coronary Angiography - adverse effects</topic><topic>Coronary artery disease</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary vessels</topic><topic>Death</topic><topic>Female</topic><topic>Heterogeneity</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Original Paper</topic><topic>Out-of-Hospital Cardiac Arrest - diagnostic imaging</topic><topic>Out-of-Hospital Cardiac Arrest - therapy</topic><topic>Patients</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Segments</topic><topic>Statistical analysis</topic><topic>Subgroups</topic><topic>Trinucleotide repeats</topic><topic>Vein & artery diseases</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hamidi, Fardin</creatorcontrib><creatorcontrib>Anwari, Elaaha</creatorcontrib><creatorcontrib>Spaulding, Christian</creatorcontrib><creatorcontrib>Hauw-Berlemont, Caroline</creatorcontrib><creatorcontrib>Vilfaillot, Aurélie</creatorcontrib><creatorcontrib>Viana-Tejedor, Ana</creatorcontrib><creatorcontrib>Kern, Karl B.</creatorcontrib><creatorcontrib>Hsu, Chiu-Hsieh</creatorcontrib><creatorcontrib>Bergmark, Brian A.</creatorcontrib><creatorcontrib>Qamar, Arman</creatorcontrib><creatorcontrib>Bhatt, Deepak L.</creatorcontrib><creatorcontrib>Furtado, Remo H. M.</creatorcontrib><creatorcontrib>Myhre, Peder L.</creatorcontrib><creatorcontrib>Hengstenberg, Christian</creatorcontrib><creatorcontrib>Lang, Irene M.</creatorcontrib><creatorcontrib>Frey, Norbert</creatorcontrib><creatorcontrib>Freund, Anne</creatorcontrib><creatorcontrib>Desch, Steffen</creatorcontrib><creatorcontrib>Thiele, Holger</creatorcontrib><creatorcontrib>Preusch, Michael R.</creatorcontrib><creatorcontrib>Zelniker, Thomas A.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>NORA - Norwegian Open Research Archives</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical research in cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hamidi, Fardin</au><au>Anwari, Elaaha</au><au>Spaulding, Christian</au><au>Hauw-Berlemont, Caroline</au><au>Vilfaillot, Aurélie</au><au>Viana-Tejedor, Ana</au><au>Kern, Karl B.</au><au>Hsu, Chiu-Hsieh</au><au>Bergmark, Brian A.</au><au>Qamar, Arman</au><au>Bhatt, Deepak L.</au><au>Furtado, Remo H. M.</au><au>Myhre, Peder L.</au><au>Hengstenberg, Christian</au><au>Lang, Irene M.</au><au>Frey, Norbert</au><au>Freund, Anne</au><au>Desch, Steffen</au><au>Thiele, Holger</au><au>Preusch, Michael R.</au><au>Zelniker, Thomas A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials</atitle><jtitle>Clinical research in cardiology</jtitle><stitle>Clin Res Cardiol</stitle><addtitle>Clin Res Cardiol</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>113</volume><issue>4</issue><spage>561</spage><epage>569</epage><pages>561-569</pages><issn>1861-0684</issn><issn>1861-0692</issn><eissn>1861-0692</eissn><abstract>Background
Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear.
Methods
We included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects.
Results
In total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91–1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89–1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00–2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82–1.33, P = 0.74; P-interaction 0.097).
Conclusion
In OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG.
Graphical abstract</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37495798</pmid><doi>10.1007/s00392-023-02264-7</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7737-3479</orcidid><orcidid>https://orcid.org/0000-0002-6444-8598</orcidid><orcidid>https://orcid.org/0000-0003-0485-2692</orcidid><orcidid>https://orcid.org/0000-0002-8284-2994</orcidid><orcidid>https://orcid.org/0000-0001-9492-6688</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1861-0684 |
| ispartof | Clinical research in cardiology, 2024-04, Vol.113 (4), p.561-569 |
| issn | 1861-0684 1861-0692 1861-0692 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10954865 |
| source | MEDLINE; NORA - Norwegian Open Research Archives; Springer Nature - Complete Springer Journals |
| subjects | Angiography Cardiac arrest Cardiology Cardiopulmonary Resuscitation Cardiovascular disease Clinical trials Coronary Angiography - adverse effects Coronary artery disease Coronary Artery Disease - complications Coronary Artery Disease - diagnostic imaging Coronary vessels Death Female Heterogeneity Hospitals Humans Ischemia Male Medical imaging Medicine Medicine & Public Health Meta-analysis Mortality Myocardial infarction Original Paper Out-of-Hospital Cardiac Arrest - diagnostic imaging Out-of-Hospital Cardiac Arrest - therapy Patients Percutaneous Coronary Intervention - adverse effects Randomized Controlled Trials as Topic Segments Statistical analysis Subgroups Trinucleotide repeats Vein & artery diseases Women |
| title | Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-13T16%3A53%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Early%20versus%20delayed%20coronary%20angiography%20in%20patients%20with%20out-of-hospital%20cardiac%20arrest%20and%20no%20ST-segment%20elevation:%20a%20systematic%20review%20and%20meta-analysis%20of%20randomized%20controlled%20trials&rft.jtitle=Clinical%20research%20in%20cardiology&rft.au=Hamidi,%20Fardin&rft.date=2024-04-01&rft.volume=113&rft.issue=4&rft.spage=561&rft.epage=569&rft.pages=561-569&rft.issn=1861-0684&rft.eissn=1861-0692&rft_id=info:doi/10.1007/s00392-023-02264-7&rft_dat=%3Cproquest_pubme%3E2843034177%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2969147328&rft_id=info:pmid/37495798&rfr_iscdi=true |