An estimated 424, 000 patients experience out-of-hospital cardiac arrest (OHCA) annually
across the United States, and only ∼10% of patients survive to hospital discharge.
1
2
Coronary artery disease (CAD) is the most common cause of OHCA, with a prevalence
as high as 70% to 80%.
3
,
- Elfwén L
- Lagedal R
- Nordberg P
- James S
- Oldgren J
- Böhm F
- Lundgren P
- Rylander C
- van der Linden J
- Hollenberg J
- Erlinge D
- Cronberg T
- Jensen U
- Friberg H
- Lilja G
- Larsson IM
- Wallin E
- Rubertsson S
- Svensson L.
Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-an
initial pilot-study of a randomized clinical trial.
Resuscitation. 2019; 139: 253-261
4
,
- Kern KB
- Radsel P
- Jentzer JC
- Seder DB
- Lee KS
- Lotun K
- Janardhanan R
- Stub D
- Hsu CH
- Noc M.
Randomized pilot clinical trial of early coronary angiography versus no early coronary
angiography after cardiac arrest without ST-segment elevation: the PEARL study.
Circulation. 2020; 142 (Published correction appears in Circulation 2020;142:e374): 2002-2012
5
Although CAD is the leading cause of OHCA, there has been a dramatic increase in
OHCA due to drug overdose.
- Hauw-Berlemont C
- Lamhaut L
- Diehl JL
- Andreotti C
- Varenne O
- Leroux P
- Lascarrou JB
- Guerin P
- Loeb T
- Roupie E
- Daubin C
- Beygui F
- Boissier F
- Marjanovic N
- Christiaens L
- Vilfaillot A
- Glippa S
- Prat JD
- Chatellier G
- Cariou A
- Spaulding C
- Investigators EMERGE
Emergency vs delayed coronary angiogram in survivors of out-of-hospital cardiac arrest:
results of the randomized, multicentric EMERGE trial.
JAMA Cardiol. 2022; 7: 700-707
6
Current guidelines recommend emergent coronary angiography among survivors of sudden
cardiac death with ST-elevation myocardial infarction (STEMI) and no obvious noncardiac
cause of cardiac arrest.
- Dezfulian C
- Orkin AM
- Maron BA
- Elmer J
- Girotra S
- Gladwin MT
- Merchant RM
- Panchal AR
- Perman SM
- Starks MA
- van Diepen S
- Lavonas EJ.
Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and
implications for health care and public responses: a scientific statement from the
American Heart Association.
Circulation. 2021; 143: e836-e870
5
However, the benefit of emergency coronary angiography in patients with cardiac arrest
without STEMI is still debatable.
- Hauw-Berlemont C
- Lamhaut L
- Diehl JL
- Andreotti C
- Varenne O
- Leroux P
- Lascarrou JB
- Guerin P
- Loeb T
- Roupie E
- Daubin C
- Beygui F
- Boissier F
- Marjanovic N
- Christiaens L
- Vilfaillot A
- Glippa S
- Prat JD
- Chatellier G
- Cariou A
- Spaulding C
- Investigators EMERGE
Emergency vs delayed coronary angiogram in survivors of out-of-hospital cardiac arrest:
results of the randomized, multicentric EMERGE trial.
JAMA Cardiol. 2022; 7: 700-707
5
Early revascularization in patients with myocardial infarction (MI) can prevent further
myocardial injury and complications related to MI.
- Hauw-Berlemont C
- Lamhaut L
- Diehl JL
- Andreotti C
- Varenne O
- Leroux P
- Lascarrou JB
- Guerin P
- Loeb T
- Roupie E
- Daubin C
- Beygui F
- Boissier F
- Marjanovic N
- Christiaens L
- Vilfaillot A
- Glippa S
- Prat JD
- Chatellier G
- Cariou A
- Spaulding C
- Investigators EMERGE
Emergency vs delayed coronary angiogram in survivors of out-of-hospital cardiac arrest:
results of the randomized, multicentric EMERGE trial.
JAMA Cardiol. 2022; 7: 700-707
7
However, early unselected coronary angiography can delay the identification and management
of other noncardiac causes of arrest.
- Desch S
- Freund A
- Akin I
- Behnes M
- Preusch MR
- Zelniker TA
- Skurk C
- Landmesser U
- Graf T
- Eitel I
- Fuernau G
- Haake H
- Nordbeck P
- Hammer F
- Felix SB
- Hassager C
- Engstrøm T
- Fichtlscherer S
- Ledwoch J
- Lenk K
- Joner M
- Steiner S
- Liebetrau C
- Voigt I
- Zeymer U
- Brand M
- Schmitz R
- Horstkotte J
- Jacobshagen C
- Pöss J
- Abdel-Wahab M
- Lurz P
- Jobs A
- de Waha-Thiele S
- Olbrich D
- Sandig F
- König IR
- Brett S
- Vens M
- Klinge K
- Thiele H
TOMAHAWK Investigators
Angiography after out-of-hospital cardiac arrest without ST-segment elevation.
Angiography after out-of-hospital cardiac arrest without ST-segment elevation.
N Engl J Med. 2021; 385: 2544-2553
7
Previous studies have investigated the role of early coronary angiography in patients
with OHCA without STEMI, but those studies showed mixed results and insufficient power
in the clinical outcomes of early routine versus delayed selective coronary angiography.
Therefore, we conducted this meta-analysis of randomized controlled trials (RCTs)
to evaluate the role of early coronary angiography in patients with OHCA without STEMI.- Desch S
- Freund A
- Akin I
- Behnes M
- Preusch MR
- Zelniker TA
- Skurk C
- Landmesser U
- Graf T
- Eitel I
- Fuernau G
- Haake H
- Nordbeck P
- Hammer F
- Felix SB
- Hassager C
- Engstrøm T
- Fichtlscherer S
- Ledwoch J
- Lenk K
- Joner M
- Steiner S
- Liebetrau C
- Voigt I
- Zeymer U
- Brand M
- Schmitz R
- Horstkotte J
- Jacobshagen C
- Pöss J
- Abdel-Wahab M
- Lurz P
- Jobs A
- de Waha-Thiele S
- Olbrich D
- Sandig F
- König IR
- Brett S
- Vens M
- Klinge K
- Thiele H
TOMAHAWK Investigators
Angiography after out-of-hospital cardiac arrest without ST-segment elevation.
Angiography after out-of-hospital cardiac arrest without ST-segment elevation.
N Engl J Med. 2021; 385: 2544-2553
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References
- Targeted hypothermia vs targeted normothermia in survivors of cardiac arrest: a systematic review and meta-analysis of randomized trials.Am J Med. 2022; 135: 626-633
- Multistate 5-year initiative to improve care for out-of-hospital cardiac arrest: primary results from the HeartRescue Project.J Am Heart Assoc. 2017; 6e005716
- Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-an initial pilot-study of a randomized clinical trial.Resuscitation. 2019; 139: 253-261
- Randomized pilot clinical trial of early coronary angiography versus no early coronary angiography after cardiac arrest without ST-segment elevation: the PEARL study.Circulation. 2020; 142 (Published correction appears in Circulation 2020;142:e374): 2002-2012
- Emergency vs delayed coronary angiogram in survivors of out-of-hospital cardiac arrest: results of the randomized, multicentric EMERGE trial.JAMA Cardiol. 2022; 7: 700-707
- Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association.Circulation. 2021; 143: e836-e870
- Angiography after out-of-hospital cardiac arrest without ST-segment elevation.N Engl J Med. 2021; 385: 2544-2553
- FFR- versus angiography-guided revascularization for nonculprit stenosis in STEMI and multivessel disease: a network meta-analysis.JACC Cardiovasc Interv. 2022; 15: 656-666
- A Randomised tRial of Expedited transfer to a cardiac arrest centre for non-ST elevation ventricular fibrillation out-of-hospital cardiac arrest: the ARREST pilot randomised trial.Resuscitation. 2017; 115: 185-191
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Article info
Publication history
Published online: December 01, 2022
Received in revised form:
October 8,
2022
Received:
August 8,
2022
Footnotes
Authors Islam Y. Elgendy and Ayman Elbadawi contributed equally to this study.
Funding: None.
Identification
Copyright
Published by Elsevier Inc.
