Abstract 19431: Early Coronary Angiography & Survival After Out-of-Hospital Cardiac Arrest: Systematic Review & Meta-Analysis
Background: Although acute myocardial infarction is a common cause of out-of-hospital cardiac arrest (OHCA), the role of early coronary angiography (ECA) in improving OHCA survival remains uncertain. In the absence of evidence from randomized clinical trials, we conducted a systematic review and meta-analysis of observational studies to determine the association of ECA in improving survival in OHCA patients.
Methods: We searched multiple electronic databases for published studies on use of ECA in OHCA between 1/1/1990 to 3/15/2015. Studies were included if 1) restricted to only OHCA 2) included an exposure group that underwent ECA within 1 day of OHCA, and a concurrent control group that did not undergo ECA and 3) reported in-hospital survival or survival with favorable neurological outcome. We used a random effects model to obtain pooled odds ratio, and the I2 statistic. A meta-regression analysis was performed to determine the extent to which heterogeneity in the pooled estimate was explained by measured study characteristics.
Results: A total of 13 studies with 14,926 patients were included. ECA was associated with higher odds of survival (pooled OR 2.68 95% CI [2.46-2.93]) However, there was significant heterogeneity among included studies (I2 88%). In meta-regression analysis, differences in study characteristics (patient age and sex; rates of witnessed cardiac arrests, bystander CPR and shockable rhythm in each study; and study quality) explained most of the observed heterogeneity (residual I2 28%). Importantly, the effect of ECA on survival outcomes was consistent in multiple pre-specified subgroups as shown in Figure.
Conclusion: Among patients resuscitated from out-of-hospital cardiac arrest, ECA is associated with higher odds of survival to discharge.
Author Disclosures: S. CarlLee: None. R. Khera: None. A. Blevins: None. M. Schweizer: None. S. Girotra: None.
- © 2016 by American Heart Association, Inc.