One-Year Outcomes of Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST Elevation: An Individual Patient Data Meta-Analysis.

Background

To compare immediate vs delayed or selective coronary angiography treatment strategies for patients with OHCA without ST elevation and the effect on 1-year survival, and identify subgroups that may differ in treatment effect based on patient or clinical features.

比较立即与延迟或选择性冠状动脉造影治疗策略对无ST段抬高的OHCA患者1年生存率的影响，并基于患者或临床特征识别可能在治疗效果上存在差异的亚组。

data_sources

Ovid MEDLINE, Embase, and Clarivate/Web of Science Core Collection were searched for relevant literature from inception to September 8, 2022.

从创刊至2022年9月8日，检索了Ovid MEDLINE、Embase和Clarivate/Web of Science Core Collection中的相关文献。

study_selection

RCTs investigating immediate vs delayed or selective coronary angiography after OHCA without ST-segment elevations and a minimum follow-up period of 1 year.

研究了在没有ST段抬高的院外心脏骤停（OHCA）后，立即与延迟或选择性冠状动脉造影的随机对照试验（RCTs），并至少有1年的随访期。

Data were combined using the 1-stage individual participant data meta-analysis(IPDMA) approach.

数据通过一阶段个体参与者数据荟萃分析(IPDMA)方法进行了合并。

data_extraction_and_synthesis

Individual patient data were obtained from RCTs that met the eligibility criteria: COACT (Coronary Angiography After Cardiac Arrest) and TOMAHAWK (Immediate Unselected Coronary Angiography vs Delayed Triage in Survivors of Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation).

从符合资格标准的随机对照试验(RCTs)中获取了个体患者数据：COACT（心脏骤停后的冠状动脉造影）和TOMAHAWK（立即无选择性冠状动脉造影与院外心脏骤停幸存者无ST段抬高延迟分诊的比较）。

main_outcomes_and_measures

The primary end point was 1-year survival. Secondary outcomes included the identification of variations in treatment effect using subgroup analysis (based on age, sex, arrest rhythm, witnessed arrest, time to basic life support, time to return of spontaneous circulation, and history of coronary artery disease, diabetes, and hypertension) and clinical outcomes (eg, myocardial infarction and heart failure) at 1 year.

主要终点是1年生存率。次要结果包括使用基于年龄、性别、停搏节律、目击停搏、基础生命支持时间、自主循环恢复时间以及冠状动脉疾病、糖尿病和高血压病史的亚组分析来识别治疗效果的变化，并在1年内评估临床结果（例如心肌梗死和心力衰竭）。

Results

For the IPDMA, data were derived from 2 RCTs comprising a total of 1031 patients.

对于个体患者数据荟萃分析（IPDMA），数据来源于2项随机对照试验（RCTs），共计1031名患者。

In the immediate angiography group, 259 of 522 (49.6%) survived until 1 year vs 272 of 509 (53.4%) in the delayed or selective angiography group (stratified by randomized trial; hazard ratio, 1.15 [95% CI, 0.96-1.37).

在立即行血管造影组中，522名患者中有259名（49.6%）存活至1年，而在延迟或选择性血管造影组中，509名患者中有272名（53.4%）存活至1年（按随机试验分层；风险比为1.15，95%置信区间为0.96-1.37）。

No treatment-by-subgroup interactions were identified that suggested heterogeneity between the 2 groups (P values for interaction ranged from P = .26 to P = .91 across subgroups).

未发现任何治疗与亚组之间的相互作用，这表明两组之间存在异质性（亚组间的交互作用P值范围从P = .26到P = .91）。

conclusions_and_relevance

In this IPDMA of 2 RCTs, there was no benefit of immediate coronary angiography compared with a delayed or selective strategy during 1-year follow-up in successfully resuscitated patients with OHCA without ST-segment elevations.

在这项包含2项随机对照试验的个体患者数据荟萃分析中，对于成功复苏的无ST段抬高型院外心脏骤停患者，在1年的随访期间，立即冠状动脉造影与延迟或选择性策略相比，并未显示出任何益处。

No subgroup of patients was identified that showed a differential treatment effect.

没有识别出任何患者亚组显示出不同的治疗效果。

trial_registration

PROSPERO Identifier: CRD42022346559; COACT Netherlands Trial Register Identifier: NTR4973; TOMAHAWK ClinicalTrials.gov Identifier: NCT02750462.

PROSPERO注册号：CRD42022346559；COACT荷兰试验注册号：NTR4973；TOMAHAWK ClinicalTrials.gov注册号：NCT02750462。