Early versus deferred coronary angiography following cardiac arrest. A systematic review and meta-analysis

Aim: The role of early coronary angiography (CAG) in the evaluation of patients presenting with out of hospital cardiac arrest (OHCA) and no ST-elevation myocardial infarction (STE) pattern on electrocardiogram (ECG) has been subject to considerable debate. We sought to assess the impact of early versus deferred CAG on mortality and neurological outcomes in patients with OHCA and no STE. Methods: OVID MEDLINE, EMBASE, Web of Science and Cochrane Library Register were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines from inception until July 18, 2022. Randomized clinical trials (RCTs) of patients with OHCA without STE that compared early CAG with deferred CAG were included. The primary endpoint was 30-day mortality. Secondary endpoints included mortality at discharge or 30-days, favourable neurology at 30-days, major bleeding, renal failure and recurrent cardiac arrest. Results: Of the 7,998 citations, 5 RCTs randomizing 1524 patients were included. Meta-analysis showed no difference in 30-day mortality with early versus deferred CAG (OR 1.17, CI 0.91 – 1.49, I² = 27%). There was no difference in favourable neurological outcome at 30 days (OR 0.88, CI 0.52 – 1.49, I² = 63%), major bleeding (OR 0.94, CI 0.33 – 2.68, I² = 39%), renal failure (OR 1.14, CI 0.77 – 1.69, I² = 0%), and recurrent cardiac arrest (OR 1.39, CI 0.79 – 2.43, I² = 0%). Conclusions: Early CAG was not associated with improved survival and neurological outcomes among patients with OHCA without STE. This meta-analysis does not support routinely performing early CAG in this select patient cohort.