Camuglia Anthony C, Randhawa Varinder K, Lavi Shahar, Walters Darren L
Mater Health Cardiovascular Unit, South Brisbane, QLD, Australia; Princess Alexandra Hospital, Department of Cardiology, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.
London Health Sciences Centre, University of Western Ontario, London, ON, Canada.
Resuscitation. 2014 Nov;85(11):1533-40. doi: 10.1016/j.resuscitation.2014.08.025. Epub 2014 Sep 4.
Survivors of out-of-hospital cardiac arrest (OHCA) have a high rate of morbidity and mortality. Invasive cardiac assessment with coronary angiography offers the potential for improving outcomes by facilitating early revascularization. The aim of the present study was to review the published data on early coronary angiography for survivors of OHCA, and its impact on survival and neurological outcomes.
Medline, Embase and PubMed were searched with a structured search query. The primary outcome was in-hospital (or if not available, 30 day or 6 month) survival. Rates of survival with good neurological outcome were a secondary endpoint. The time period of the search was from 1 January 1980 to 1 January 2014. Data was pooled with means and 95% CI interval calculated. Meta-analysis of the main outcomes was performed using a weighted random effects model.
Following review of all identified records, 105 relevant full text articles were retrieved. Fifty had adequate outcome information stratified by the use of coronary angiography for analysis. In studies where a control group was available for comparison, the overall survival in the acute angiography group was 58.8% versus 30.9% in the control group (Odds ratio 2.77, 95% CI 2.06-3.72). Survival with good neurological outcome (as per the Utstein framework) in the early angiography group was 58% versus 35.8% in the control group (Odds ratio 2.20, 95% CI 1.46-3.32).
Early coronary angiography in patients following OHCA is associated with improved outcome and better survival.
院外心脏骤停（OHCA）幸存者的发病率和死亡率很高。通过冠状动脉造影进行有创心脏评估有可能通过促进早期血运重建来改善预后。本研究的目的是回顾已发表的关于OHCA幸存者早期冠状动脉造影的数据，及其对生存和神经功能结局的影响。
使用结构化检索式对Medline、Embase和PubMed进行检索。主要结局是住院期间（或若无此数据，则为30天或6个月）的生存率。神经功能良好的生存率是次要终点。检索时间段为1980年1月1日至2014年1月1日。汇总数据并计算均值和95%可信区间。使用加权随机效应模型对主要结局进行荟萃分析。
在对所有识别出的记录进行回顾后，检索到105篇相关全文文章。其中50篇有足够的结局信息，可按冠状动脉造影的使用情况进行分层分析。在有对照组可供比较的研究中，急性血管造影组的总体生存率为58.8%，而对照组为30.9%（比值比2.77，95%可信区间2.06 - 3.72）。早期血管造影组神经功能良好的生存率（根据Utstein框架）为58%，而对照组为35.8%（比值比2.20，95%可信区间1.46 - 3.32）。
OHCA患者早期冠状动脉造影与改善预后和提高生存率相关。
