University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany.
Eur Heart J. 2023 Mar 21;44(12):1040-1054. doi: 10.1093/eurheartj/ehac611.
This network meta-analysis aimed to assess the effect of early coronary angiography (CAG) compared with selective CAG (late and no CAG) for patients after out-of-hospital cardiac arrest without ST-elevation myocardial infarction (NSTE-OHCA).
A systematic literature search was performed using the EMBASE, MEDLINE and Web of Science databases without restrictions on publication date. The last search was performed on 15 July 2022. Randomized controlled trials (RCTs) and non-randomized studies (NRS) comparing the effect of early CAG to selective CAG after NSTE-OHCA on survival and/or neurological outcomes were included. Meta-analyses were performed based on a DerSimonian-Laird random effects model. A total of 18 studies were identified by the literature search. After the exclusion of two studies due to high risk of bias, 16 studies (six RCTs, ten NRS) were included in the final analyses. Meta-analyses showed a statistically significant increase in survival after early CAG compared with selective CAG in the overall analysis [OR: 1.40, 95% confidence interval (CI): (1.12-1.76), P < 0.01, I2 = 68%]. This effect was lost in the subgroup analysis of RCTs [OR: 0.89, 95% CI: (0.73-1.10), P = 0.29, I2 = 0%]. Random effects model network meta-analysis of NRS based on a Bayesian method showed statistically significant increased survival after late compared with early CAG [OR: 4.20, 95% CI: (1.22, 20.91)].
The previously reported superiority of early CAG after NSTE-OHCA is based on NRS at high risk of selection and survivorship bias. The meta-analysis of RCTs does not support routinely performing early CAG after NSTE-OHCA.
本网络荟萃分析旨在评估与选择性冠状动脉造影（选择性 CAG，即晚期和无 CAG）相比，急性非 ST 段抬高型心肌梗死（NSTE-OHCA）后院外心脏骤停患者行早期冠状动脉造影（早期 CAG）的效果。
我们使用 EMBASE、MEDLINE 和 Web of Science 数据库进行了系统文献检索，对发表日期不设限制。最后一次检索是在 2022 年 7 月 15 日进行的。我们纳入了比较 NSTE-OHCA 后早期 CAG 与选择性 CAG 对生存和/或神经结局影响的随机对照试验（RCT）和非随机研究（NRS）。Meta 分析基于 DerSimonian-Laird 随机效应模型进行。通过文献检索共确定了 18 项研究。排除了两项因偏倚风险高而被剔除的研究后，最终有 16 项研究（6 项 RCT，10 项 NRS）被纳入最终分析。Meta 分析显示，总体分析中早期 CAG 较选择性 CAG 后生存率有统计学显著提高[OR：1.40，95%置信区间（CI）：（1.12-1.76），P < 0.01，I² = 68%]。在 RCT 亚组分析中，这一效果消失[OR：0.89，95% CI：（0.73-1.10），P = 0.29，I² = 0%]。基于贝叶斯法的 NRS 随机效应模型网络荟萃分析显示，晚期 CAG 后生存率明显高于早期 CAG[OR：4.20，95% CI：（1.22，20.91）]。
之前报道的 NSTE-OHCA 后早期 CAG 的优势是基于选择和生存偏差风险高的 NRS。RCT 的荟萃分析不支持常规对 NSTE-OHCA 后行早期 CAG。
