Early vs Delayed Coronary Angiography in Out-of-Hospital Cardiac Arrest Patients Without ST-Segment Elevation: An Updated Meta-Analysis of Randomized Controlled Trials

Background: The routine practice of early coronary angiography in patients who have suffered an out-of-hospital cardiac arrest without ST-segment elevation remains a subject of controversy. Methods: We searched electronic databases for randomized controlled trials that compared early or emergency coronary angiography with delayed or no coronary angiography in patients who had an out-of-hospital cardiac arrest without ST-segment elevation. A random-effects meta-analysis was performed to estimate the odds ratio (OR) with a 95% confidence interval (CI). The outcomes of interest were mortality and neurological prognosis, based on the cerebral performance categories (CPC 1–2) scale. Results: Seven studies involving 1623 patients (the early group [n=816] and the delayed group [n=807]) were included in the final analysis. Compared to delayed coronary angiography, early coronary angiography was associated with similar odds of mortality (OR, 1.07; 95% CI, 0.87 to 1.31; P=0.52) and a favorable neurological prognosis (OR, 0.97; 95% CI, 0.78 to 1.19; P=0.74). Conclusions: For patients with an out-of-hospital cardiac arrest without ST-segment elevation, there was no benefit concerning mortality and neurological prognosis with early coronary angiography compared with delayed coronary angiography. (Iranian Heart Journal 2024; 25(2): 26-34).