Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, USA.
Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, USA.
Resuscitation. 2019 Nov;144:137-144. doi: 10.1016/j.resuscitation.2019.06.279. Epub 2019 Sep 30.
Performing immediate coronary angiography (CAG) in patients with a cardiac arrest and a non-ST-elevation myocardial infarction (NSTEMI) remains a highly debated topic. We performed a meta-analysis aiming to evaluate the influence of immediate, delayed, and no CAG in patients with cardiac arrest and NSTEMI.
A comprehensive literature review of Pubmed/MEDLINE, Cochrane Library, and Embase was performed for all studies that compared immediate CAG to delayed or no CAG in the setting of cardiac arrest and NSTEMI. The primary outcome was long-term mortality and secondary outcomes included short-term mortality and a Cerebral Performance Category (CPC) score of 1-2 at the longest follow-up period. A random-effects model was used to report odds ratios (ORs) with Bayesian 95% credible intervals (CrIs), and ORs with 95% confidence intervals (CIs) for both network and direct meta-analyses, respectively.
11 studies were included in the final analysis: 8 observational, 1 post-hoc analysis and 2 randomized trials, totaling 3702 patients. The mean age was 63.8±12.8 years with 78% males. We found that immediate and delayed CAG were associated with lower long-term mortality when compared to no CAG (OR 0.21; 95% CrI 0.05-0.82) and (OR 0.11; 95% CrI 0.03-0.43), as well as lower short-term mortality (OR 0.17; 95% CrI 0.04-0.64) and (OR 0.07; 95% CrI 0.01-0.29), respectively. In addition, immediate and delayed CAG were associated with a significantly higher number of patients with a CPC score of 1-2 (OR 4.15; 95% CrI 1.10-16.10) and (OR 4.67; 95% CrI 1.53-15.12), respectively. There were no significant differences between immediate or delayed CAG regarding long-term mortality, short-term mortality, or favorable CPC score.
Among patients who survived cardiac arrest with an NSTEMI, CAG is associated with a higher rate of survival and favorable neurological outcomes compared with no CAG. There were no differences between immediate and delayed strategies.
对存在心脏骤停和非 ST 段抬高型心肌梗死（NSTEMI）的患者进行即刻冠状动脉造影（CAG）仍然是一个极具争议的话题。我们进行了一项荟萃分析，旨在评估在心脏骤停和 NSTEMI 患者中即刻、延迟和无 CAG 的影响。
对 Pubmed/MEDLINE、Cochrane 图书馆和 Embase 中的所有研究进行了全面的文献回顾，这些研究比较了心脏骤停和 NSTEMI 患者中即刻 CAG 与延迟或无 CAG 的比较。主要结局是长期死亡率，次要结局包括短期死亡率和最长随访期间的神经功能预后良好（Cerebral Performance Category，CPC）评分 1-2。使用随机效应模型报告优势比（OR），贝叶斯 95%可信区间（CrI），以及网络和直接荟萃分析的 OR 及其 95%置信区间（CI）。
最终分析纳入 11 项研究：8 项观察性研究，1 项事后分析和 2 项随机试验，共纳入 3702 例患者。平均年龄为 63.8±12.8 岁，男性占 78%。我们发现，与无 CAG 相比，即刻和延迟 CAG 与较低的长期死亡率相关（OR 0.21；95% CrI 0.05-0.82）和（OR 0.11；95% CrI 0.03-0.43），以及较低的短期死亡率（OR 0.17；95% CrI 0.04-0.64）和（OR 0.07；95% CrI 0.01-0.29）。此外，即刻和延迟 CAG 与更高比例的 CPC 评分 1-2 患者相关（OR 4.15；95% CrI 1.10-16.10）和（OR 4.67；95% CrI 1.53-15.12）。即刻和延迟 CAG 之间在长期死亡率、短期死亡率或良好的 CPC 评分方面没有显著差异。
在存在 NSTEMI 的心脏骤停患者中，与无 CAG 相比，CAG 与更高的生存率和良好的神经功能预后相关。即刻和延迟策略之间没有差异。
