Rate-control vs. rhythm-control in patients with atrial fibrillation: a meta-analysis
Rate-control vs. rhythm-control in patients with atrial fibrillation: a meta-analysis
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DOI：
10.1093/eurheartj/ehi306
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发表时间：
2005-10-01
影响因子：
39.3
通讯作者：
Crea, F
中科院分区：
文献类型：
--
作者：
Testa, L;Biondi-Zoccai, GGL;Crea, F
Aims To systematically assess the risk/benefit ratio of a rate-control strategy vs. a rhythm-control strategy in patients with first or recurrent atrial fibrillation（AF）.Methods and results我们在Medline、CENTRAL和其他来源中搜索了2004年9月之前的随机试验。计算了全因死亡和血栓栓塞性卒中（CEP）、大出血（颅内和颅外）和全身性栓塞联合终点的个体和合并随机效应比值比（OR）和95%置信区间（CI）[OR（95% CI）]。还评估了避免一个CEP所需治疗的数量（NNT）和异质性。5项研究纳入了5239例房颤患者，比较了心率控制与节律控制。平均随访时间为1 - 3.5年。与节律控制方法相比，心率控制策略与CEP风险显著降低相关[OR 0.84（0.73，0.98），P=0.02]，并有降低死亡风险[OR 0.87（0.74，1.02），P=0.09]和血栓栓塞性卒中风险[OR 0.80（0.6，1.07），P=0.14]的趋势。拯救一个CEP的NNT是50。大出血[OR 1.14（0.9，1.45），P=0.28]和全身栓塞[OR 0.93（0.43，2.02），P=0.90]的风险无显著差异。结论5239例房颤患者的Meta分析表明，初始心率控制策略较节律控制策略预后更好，可作为新治疗方法的标准治疗方法。
Aims To systematically assess the risk/benefit ratio of a rate-control strategy vs. a rhythm-control strategy in patients with first or recurrent atrial fibrillation (AF).Methods and results We searched Medline, CENTRAL, and other sources up to September 2004 for randomized trials. Individual and pooled random-effect odd ratios (OR) and 95% confidence intervals (CI) [OR (95% CI)] were calculated for the combined endpoint of all cause death and thromboembolic stroke (CEP), major bleeds (intra and extracranial), and systemic embolism. Number needed to treat (NNT) to avoid one CEP and heterogeneity were also assessed. Five studies enrolling 5239 patients with AF compared rate-control vs. rhythm-control. Average follow-up ranged from 1 to 3.5 years. A rate-control strategy compared with a rhythm-control approach was associated with a significantly reduced risk of CEP [OR 0.84 (0.73, 0.98), P=0.02], and with a trend towards a reduced risk of death [OR 0.87 (0.74, 1.02), P=0.09] and thromboembolic stroke [OR 0.80 (0.6, 1.07), P=0.14]. NNT to save one CEP was 50. There was no significant difference in the risk of major bleeds [OR 1.14 (0.9, 1.45), P=0.28] and systemic embolism [OR 0.93 (0.43, 2.02), P=0.90]. No significant heterogeneity was found in any of the analyses (P > 0.1).Conclusion This meta-analysis of 5239 patients with AF indicates that an initial rate-control strategy compared with a rhythm-control one is associated with a better prognosis, thus representing the standard treatment against which to test new therapeutic approaches.