Meta-Analysis of Individual Patient Data of Sodium Bicarbonate and Sodium Chloride for All-Cause Mortality After Coronary Angiography

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• 作者：Jeremiah R. Brown ; PhD^a ; ^b ; ^c ; ^{jbrown@dartmouth.edu" class="auth_mail" title="E-mail the corresponding author} ; Daniel M. Pearlman ; MPH^a ; Emily J. Marshall ; MPH^a ; Shama S. Alam ; PhD^a ; Todd A. MacKenzie ; PhD^a ; ^b ; ^c ; Alejandro Recio-Mayoral ; MD^d ; Vitor O. Gomes ; MD ; PhD^e ; Bokyung Kim ; MS^a ; Lisette O. Jensen ; MD ; PhD^f ; Christian Mueller ; MD^g ; Mauro Maioli ; MD^h ; Richard J. Solomon ; MDⁱ
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：15 November 2016
• 年：2016
• 卷：118
• 期：10
• 页码：1473-1479
• 全文大小：316 K

文摘

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.