Coronary angiography in patients without ST-segment elevation following out-of-hospital cardiac arrest. COUPE clinical trial

Viana-Tejedor, Ana; Andrea-Riba, Rut; Scardino, Claudia; Arizá-Solé, Albert; Bañeras, Jordi; García-García, Cosme; Mena, Manuel Jiménez; Vila, Monserrat; Martínez‐Sellés, Manuel; Pastor, Gemma; Acuña, José María García; Loma-Osorio, Pablo; Rubira, Juan Carlos García; Pérez, Pablo Jorge; Pastor, Pablo; Ferrera, Carlos; Noriega, Francisco J.; Macías, Natalia Pérez; Fernández-Ortíz, Antonio; Pérez-Villacastı́n, Julián

doi:10.1016/j.rec.2022.05.013

Cited by 7 publications

(19 citation statements)

References 23 publications

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“…One trial was originally included as an abstract; however, upon publication of the article after our search was completed, we did a full text review and included this trial in our analysis ( 18 ). A further recent RCT was published during the peer review process and was included in our analysis ( 20 ).…”

Section: Resultsmentioning

confidence: 99%

“…One trial only included patients with initial shockable arrest rhythm ( 17 ). The timing of early angiography varied among studies: immediately after randomization in two trials ( 16 , 18 ), within 1 hour of patient presentation in one trial ( 14 ), and within 2 hours of patient presentation in three trials ( 15 , 17 , 20 ). In the trials with early angiography immediately after presentation, one did not provide time from arrest to angiography ( 16 ), whereas the other trial had a median time from arrest to angiography of 2 hours ( 18 ).…”

Section: Resultsmentioning

confidence: 99%

“…Culprit or unstable lesion was not described in one trial, but percutaneous coronary intervention was performed in 55 of 200 patients (27.5%) receiving angiography ( 18 ). Five of the included trials were judged to be at probably low RoB ( 14 , 15 , 17 , 18 , 20 ) and one trial at high RoB ( 16 ) (see Table 1 for RoB judgments).…”

Section: Resultsmentioning

confidence: 99%

“…The results of this analysis are consistent with a previous meta-analysis of RCTs addressing the question that did not include the most recently published RCTs ( 19 ). That being said, by including the Emergency versus Delayed Coronary Angiogram in Survivors of OHCA Without ST-Segment Elevation trial ( n = 279) and the Coronary Angiography in Patients Without ST-segment Elevation Following OHCA trial ( n = 66), which were not included in the previous review ( 18 , 20 ), we have achieved a higher degree of precision in findings which may provide stronger conclusions. Other incremental additions of this review compared with previous meta-analyses on the topic include using the GRADE approach to assess certainty in estimates of effect and excluding two studies which had been included in previously published meta-analysis but which were deemed ineligible for this meta-analysis ( 30 , 31 ).…”

Section: Discussionmentioning

confidence: 99%

“…A number of recently published randomized controlled trials (RCTs) have investigated the benefit of early coronary angiography in patients without ST elevation on ECG after ROSC (14)(15)(16)(17)(18), and some of these studies have been summarized in a recent systematic review (19). However, this review included both post hoc observational data and RCTs, did not include two more recent RCTs (18,20), and did not assess the certainty of their summarized evidence (19). As such, the objective of this study was to conduct an updated systematic review and meta-analysis of RCTs to evaluate the safety and efficacy of early versus delayed angiography in patients without ST elevation post ROSC.…”

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confidence: 99%

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Early Versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Lawati

Forestell

Binbraik

et al. 2023

Critical Care Explorations

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OBJECTIVES: The optimal timing of coronary angiography remains unclear following out-of-hospital cardiac arrest (OHCA) without ST elevation on electrocardiogram. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of early angiography versus delayed angiography following OHCA without ST elevation. DATA SOURCES: The databases MEDLINE, PubMed EMBASE, and CINHAL, as well as unpublished sources from inception to March 9, 2022. STUDY SELECTION: A systematic search was performed for randomized controlled trials of adult patients after OHCA without ST elevation who were randomized to early as compared to delayed angiography. DATA EXTRACTION: Reviewers screened and abstracted data independently and in duplicate. The certainty of evidence was assessed for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach. The protocol was preregistered (CRD 42021292228). DATA SYNTHESIS: Six trials were included (n = 1,590 patients). Early angiography probably has no effect on mortality (relative risk [RR] 1.04; 95% CI 0.94–1.15; moderate certainty) and may have no effect on survival with good neurologic outcome (RR 0.97; 95% CI 0.87–1.07; low certainty) or ICU length of stay (LOS) (mean difference 0.41 days fewer; 95% CI –1.3 to 0.5 d; low certainty). Early angiography has an uncertain effect on adverse events. CONCLUSIONS: In OHCA patients without ST elevation, early angiography probably has no effect on mortality and may have no effect on survival with good neurologic outcome and ICU LOS. Early angiography has an uncertain effect on adverse events.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Early Versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Lawati

Forestell

Binbraik

et al. 2023

Critical Care Explorations

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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

Hamidi¹,

Anwari²,

Spaulding³

et al. 2023

Clin Res Cardiol

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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

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Coronary angiography after out-of-hospital cardiac arrest without ST-segment elevation: a systematic review and meta-analysis of randomised trials

Ferraz Costa,

Santos,

Sousa

et al. 2023

Coronary Artery Disease

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Background Out-of-hospital cardiac arrest (OHCA) has a poor prognosis. The optimal timing and role of early coronary angiography (CAG) in OHCA patients without ST-segment elevation remains unclear. The goal of this study is to compare an early CAG versus delayed CAG strategy in OHCA patients without ST elevation. Methods We systematically searched PubMed, Embase and Cochrane databases, in June 2022, for randomised controlled trials (RCTs) comparing early versus delayed early CAG. A random effects meta-analysis was performed. Results A total of seven RCTs were included, providing a total of 1625 patients: 816 in an early strategy and 807 in a delayed strategy. In terms of outcomes assessed, our meta-analysis revealed a similar rate of all-cause mortality (pooled odds ratio [OR] 1.22 [0.99–1.50], P = 0.06, I2 = 0%), neurological status (pooled OR 0.94 [0.74–1.21], = 0.65, I2 = 0%), need of renal replacement therapy (pooled OR 1.11 [0.78–1.74], P = 0.47, I2 = 0%) and major bleeding events (pooled OR 1.51 [0.95–2.40], P = 0.08, I2 = 69%). Conclusion According to our meta-analysis, in patients who experienced OHCA without ST elevation, early CAG is not associated with reduced mortality or an improved neurological status.

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Coronary angiography in patients without ST-segment elevation following out-of-hospital cardiac arrest. COUPE clinical trial

Cited by 7 publications

References 23 publications

Early Versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Early Versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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

Coronary angiography after out-of-hospital cardiac arrest without ST-segment elevation: a systematic review and meta-analysis of randomised trials

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