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Arrhythmias and sudden death
Original research article
Early coronary angiography and survival after out-of-hospital cardiac arrest: a systematic review and meta-analysis
  1. Rohan Khera1,
  2. Sheena CarlLee2,
  3. Amy Blevins3,
  4. Marin Schweizer1,4 and
  5. Saket Girotra4,5
  1. 1 Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  2. 2 Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
  3. 3 Ruth Lilly Medical Library, University of Indiana, Indiana University School of Medicine, Indianapolis, Indiana, USA
  4. 4 Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA
  5. 5 Division of Cardiology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
  1. Correspondence to Dr Saket Girotra; saket-girotra{at}uiowa.edu

Abstract

Background Although acute myocardial infarction is a common cause of out-of-hospital cardiac arrest (OHCA), the role of early coronary angiography in OHCA remains uncertain. We conducted a meta-analysis of observational studies to determine the association of early coronary angiography with survival in OHCA.

Methods We searched multiple electronic databases for published studies on early coronary angiography in OHCA between 1 January 1990 and 18 January 2017. Studies were included if (1) restricted to only OHCA, (2) included an exposure group that underwent early coronary angiography within 1  day of arrest onset and a concurrent control group that did not undergo early coronary angiography, and (3) reported survival outcomes. We used a random-effects model to obtain pooled OR. I2 statistics and Cochran’s Q test were used to determine between-study heterogeneity.

Results A total of 17 studies with 14 972 patients were included, of whom 6424 (44%) received early coronary angiography. Early coronary angiography was associated with higher odds of survival (pooled OR 2.54 (95% CI 1.94 to 3.33)) and survival with favourable neurological outcome (pooled OR 2.37 (95%  CI 1.71 to 3.28)). However, there was substantial heterogeneity in our pooled estimate (I2=88%  and p value for Cochran’s test <0.0001 for both outcomes). The large heterogeneity in pooled estimates was reduced after including adjusted estimates when available, and was explained by differences in methodological rigour and characteristics of included studies.

Conclusion Among patients resuscitated from OHCA, early coronary angiography is associated with increased survival to discharge and favourable neurological outcome.

  • coronary angiography
  • out-of-hospital cardiac arrest
  • survival

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2018-000809

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    Footnotes

    • RK and SC are joint first authors.

    • RK and SC contributed equally.

    • Funding This study is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under awards K08HL122527 (SG). RK received support from the National Heart, Lung, and Blood Institute (5T32HL125247 – 02) and the National Center for Advancing Translational Sciences (UL1TR001105) of the National Institutes of Health. MS received support from a VA Health Services Research and Development Career Development Award (award 11-215). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Given that the meta-analysis only included data from previously published studies and individual patient-level data were not used, the study was considered exempt from institutional review board approval.

    • Provenance and peer review Not commissioned; externally peer reviewed.