Effects of mineralocorticoid receptor antagonists on the risk of sudden cardiac death in patients with left ventricular systolic dysfunction: a meta-analysis of randomized controlled trials.
Effects of mineralocorticoid receptor antagonists on the risk of sudden cardiac death in patients with left ventricular systolic dysfunction: a meta-analysis of randomized controlled trials.
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DOI：
10.1161/circheartfailure.112.000003
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发表时间：
2013-03
期刊：
影响因子：
--
通讯作者：
Masoudi FA
中科院分区：
文献类型：
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作者：
Bapoje SR;Bahia A;Hokanson JE;Peterson PN;Heidenreich PA;Lindenfeld J;Allen LA;Masoudi FA
心脏性猝死(SCD)是左心室收缩功能不全患者的重要死亡原因。盐皮质激素受体拮抗剂(MRAs)可以减轻这种风险。这项荟萃分析的目的是评估MRAS对左心室收缩功能不全患者SCD的影响。我们系统地搜索了PubMed、EMBASE、Cochrane和其他数据库，直到2012年3月30日，没有语言限制。我们纳入了纳入左心室射血分数为≤45%的患者的试验，随机将受试者分为MRAS组和对照组，并报告了SCD、总死亡率和心血管死亡率的结果。已发表的8项试验招募了11875名患者，符合纳入标准。其中，6个报告了SCD和心血管死亡率的数据，7个报告了总死亡率的数据。在试验中没有观察到异质性。接受MRAS治疗的患者发生SCD的几率比对照组低23%(优势比为0.77；95%可信区间为0.66-0.89；P=0.001)。心血管疾病(0.75；95%可信区间0.68-0.84；P<；0.001)和总死亡率(优势比0.74；95%可信区间0.63-0.86；P<；0.001)也有类似的下降。虽然观察到了发表偏倚，但在修剪和填充测试后结果没有改变，这表明这种偏倚的影响可能是微不足道的。MRAS可降低左心室收缩功能不全患者发生SCD的风险。为了指导临床决策，需要在常规护理中进行MRAS对SCD的比较有效性研究，以及评估接受最佳MRA治疗的患者预防SCD的其他治疗方法的有效性。
Sudden cardiac death (SCD) is an important cause of death in patients with left ventricular systolic dysfunction. Mineralocorticoid receptor antagonists (MRAs) may attenuate this risk. The objective of this meta-analysis was to assess the impact of MRAs on SCD in patients with left ventricular systolic dysfunction. We systematically searched PubMed, EMBASE, Cochrane, and other databases through March 30, 2012, without language restrictions. We included trials that enrolled patients with left ventricular ejection fraction of ≤45%, randomized subjects to MRAs versus control and reported outcomes on SCD, total and cardiovascular mortality. Eight published trials that enrolled 11875 patients met inclusion criteria. Of these, 6 reported data on SCD and cardiovascular mortality, and 7 reported data on total mortality. No heterogeneity was observed among the trials. Patients treated with MRAs had 23% lower odds of experiencing SCD compared with controls (odds ratio, 0.77; 95% confidence interval, 0.66–0.89; P=0.001). Similar reductions were observed in cardiovascular (0.75; 95% confidence interval, 0.68– 0.84; P<0.001) and total mortality (odds ratio, 0.74; 95% confidence interval, 0.63–0.86; P<0.001). Although publication bias was observed, the results did not change after a trim and fill test, suggesting that the impact of this bias was likely insignificant. MRAs reduce the risk of SCD in patients with left ventricular systolic dysfunction. Comparative effectiveness studies of MRAs on SCD in usual care as well as studies evaluating the efficacy of other therapies to prevent SCD in patients receiving optimal MRA therapy are needed to guide clinical decision-making.