Meta-Analysis of Individual Patient Data of Sodium Bicarbonate and Sodium Chloride for All-Cause Mortality After Coronary Angiography.
Meta-Analysis of Individual Patient Data of Sodium Bicarbonate and Sodium Chloride for All-Cause Mortality After Coronary Angiography.
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DOI：
10.1016/j.amjcard.2016.08.008
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发表时间：
2016-11
期刊：
影响因子：
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通讯作者：
Jeremiah R. Brown;Daniel M. Pearlman;E. Marshall;Shama S. Alam;T. Mackenzie;A. Recio-Mayoral;V. Gomes;Bokyung Kim;L. Jensen;C. Mueller;M. Maioli;R. Solomon
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文献类型：
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作者：
Jeremiah R. Brown;Daniel M. Pearlman;E. Marshall;Shama S. Alam;T. Mackenzie;A. Recio-Mayoral;V. Gomes;Bokyung Kim;L. Jensen;C. Mueller;M. Maioli;R. Solomon
我们试图研究碳酸氢钠预防造影剂相关肾病（CAN）与死亡率之间的关系。我们对来自多个随机对照试验的个体患者数据进行了荟萃分析。我们获得了10项符合条件的试验中7项的个体患者数据集（2,764名参与者中的2,292名）。对于其余3项试验，根据其原始报告中描述的随访期推算出事件发生时间数据。我们纳入了所有对接受冠状动脉造影或其他动脉介入治疗的患者进行术中静脉注射碳酸氢钠与术中静脉注射氯化钠比较的试验。纳入的试验是根据预先确定的资格标准一致确定的。主要终点是全因死亡率风险，定义为从随机分组到死亡的时间。在共有2764名受试者的10项试验中，碳酸氢钠在1年内的死亡率风险低于氯化钠（风险比0.61,95%可信区间[CI] 0.41至0.89,p = 0.011）。尽管围手术期碳酸氢钠与CAN发病率的降低相关（相对危险度0.75,95% CI 0.62 ~ 0.91, p = 0.003），但对死亡率的影响与CAN的发生之间存在统计学上显著的相互作用（风险比5.65,95% CI 3.58 ~ 8.92, p <0.001）。围手术期静脉注射碳酸氢钠似乎与接受冠状动脉造影或其他动脉内介入治疗的患者的长期死亡率降低有关。
We sought to examine the relation between sodium bicarbonate prophylaxis for contrast-associated nephropathy (CAN) and mortality. We conducted an individual patient data meta-analysis from multiple randomized controlled trials. We obtained individual patient data sets for 7 of 10 eligible trials (2,292 of 2,764 participants). For the remaining 3 trials, time-to-event data were imputed based on follow-up periods described in their original reports. We included all trials that compared periprocedural intravenous sodium bicarbonate to periprocedural intravenous sodium chloride in patients undergoing coronary angiography or other intra-arterial interventions. Included trials were determined by consensus according to predefined eligibility criteria. The primary outcome was all-cause mortality hazard, defined as time from randomization to death. In 10 trials with a total of 2,764 participants, sodium bicarbonate was associated with lower mortality hazard than sodium chloride at 1 year (hazard ratio 0.61, 95% confidence interval [CI] 0.41 to 0.89, p = 0.011). Although periprocedural sodium bicarbonate was associated with a reduction in the incidence of CAN (relative risk 0.75, 95% CI 0.62 to 0.91, p = 0.003), there exists a statistically significant interaction between the effect on mortality and the occurrence of CAN (hazard ratio 5.65, 95% CI 3.58 to 8.92, p <0.001) for up to 1-year mortality. Periprocedural intravenous sodium bicarbonate seems to be associated with a reduction in long-term mortality in patients undergoing coronary angiography or other intra-arterial interventions.