Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Open Heart. 2018 Oct 19;5(2):e000809. doi: 10.1136/openhrt-2018-000809. eCollection 2018.
Although acute myocardial infarction is a common cause of out-of-hospital cardiac arrest (OHCA), the role of early coronary angiography in OHCA remains uncertain. We conducted a meta-analysis of observational studies to determine the association of early coronary angiography with survival in OHCA.
We searched multiple electronic databases for published studies on early coronary angiography in OHCA between 1 January 1990 and 18 January 2017. Studies were included if (1) restricted to only OHCA, (2) included an exposure group that underwent early coronary angiography within 1 day of arrest onset and a concurrent control group that did not undergo early coronary angiography, and (3) reported survival outcomes. We used a random-effects model to obtain pooled OR. I statistics and Cochran's Q test were used to determine between-study heterogeneity.
A total of 17 studies with 14 972 patients were included, of whom 6424 (44%) received early coronary angiography. Early coronary angiography was associated with higher odds of survival (pooled OR 2.54 (95% CI 1.94 to 3.33)) and survival with favourable neurological outcome (pooled OR 2.37 (95% CI 1.71 to 3.28)). However, there was substantial heterogeneity in our pooled estimate (I=88% and p value for Cochran's test <0.0001 for both outcomes). The large heterogeneity in pooled estimates was reduced after including adjusted estimates when available, and was explained by differences in methodological rigour and characteristics of included studies.
Among patients resuscitated from OHCA, early coronary angiography is associated with increased survival to discharge and favourable neurological outcome.
虽然急性心肌梗死是院外心脏骤停（OHCA）的常见原因，但早期冠状动脉造影在 OHCA 中的作用仍不确定。我们对观察性研究进行了荟萃分析，以确定早期冠状动脉造影与 OHCA 患者存活的关系。
我们检索了 1990 年 1 月 1 日至 2017 年 1 月 18 日期间发表的关于 OHCA 早期冠状动脉造影的多个电子数据库中的研究。如果符合以下标准，则纳入研究：（1）仅限制为 OHCA；（2）纳入了在发病后 1 天内接受早期冠状动脉造影的暴露组和未接受早期冠状动脉造影的同期对照组；（3）报告了存活结果。我们使用随机效应模型获得汇总比值比。I²统计量和 Cochran's Q 检验用于确定研究间的异质性。
共纳入 17 项研究，涉及 14972 例患者，其中 6424 例（44%）接受了早期冠状动脉造影。早期冠状动脉造影与存活几率升高相关（汇总比值比 2.54，95%置信区间 1.94 至 3.33），与良好神经功能结局的存活几率升高相关（汇总比值比 2.37，95%置信区间 1.71 至 3.28）。然而，我们的汇总估计存在显著的异质性（I²=88%，两种结局的 Cochran's 检验 p 值均<0.0001）。在纳入有调整估计值的研究后，汇总估计值的异质性显著降低，这可以用纳入研究的方法学严谨性和特征的差异来解释。
在从 OHCA 复苏的患者中，早期冠状动脉造影与出院时存活和良好神经功能结局的几率增加相关。
