Department of Internal Medicine, Providence Hospital, Southfield, Michigan, USA.
Am J Cardiol. 2010 Sep 1;106(5):742-7. doi: 10.1016/j.amjcard.2010.04.034. Epub 2010 Jul 23.
In October 2007, the Federal Drug Agency issued a black box warning for contrast agents used in patients undergoing echocardiography and restricted their use in patients with acute coronary syndrome, a decompensated heart, and respiratory failure. We performed a systemic review and meta-analysis to study the adverse effects of contrast agents used with respect to myocardial infarction and all-cause mortality. MEDLINE, EMBASE, BIOSIS, and Cochrane databases from inception to October 2009 were searched for studies that reported myocardial infarction and all-cause mortality after the use of contrast agents for echocardiography. A total of 8 studies were included in the present meta-analysis. A random-effect model was used, and between-studies heterogeneity was estimated with I(2). A total of 8 studies reported death as an outcome and only 4 reported myocardial infarction. The incidence of death in the contrast group was 0.34% (726 of 211,162 patients) compared to 0.9% (45,970 of 5,078,666 patients) in the noncontrast group. The pooled odds ratio was 0.57 (95% confidence interval 0.32 to 1.01, p = 0.05). The reported incidence of myocardial infarction in the contrast group was 0.15% (86 of 57,264 patients) compared to 0.2% (92 of 44,503 patients) in the noncontrast group. The pooled odds ratio was 0.85 (95% confidence interval 0.35 to 2.05, p = 0.72). Significant heterogeneity was seen among the studies. In conclusion, the cumulative evidence has suggested that the use of contrast agents for echocardiography is safe and not associated with a greater incidence of myocardial infarction or and mortality.
2007 年 10 月，美国联邦药物管理局发布了一项黑框警告，提醒在进行超声心动图检查的患者中使用造影剂，并限制其在急性冠状动脉综合征、心功能失代偿和呼吸衰竭的患者中使用。我们进行了系统评价和荟萃分析，以研究造影剂使用与心肌梗死和全因死亡率之间的不良影响。从 2009 年 10 月起，检索 MEDLINE、EMBASE、BIOSIS 和 Cochrane 数据库，以获取报告使用造影剂进行超声心动图检查后发生心肌梗死和全因死亡率的研究。本荟萃分析共纳入 8 项研究。采用随机效应模型，并使用 I(2)估计研究间异质性。共有 8 项研究报告了死亡作为结局，仅有 4 项研究报告了心肌梗死。造影剂组的死亡率为 0.34%（211162 例患者中的 726 例），而非造影剂组为 0.9%（5078666 例患者中的 45970 例）。合并的优势比为 0.57（95%置信区间 0.32 至 1.01，p=0.05）。造影剂组报告的心肌梗死发生率为 0.15%（57264 例患者中的 86 例），而非造影剂组为 0.2%（44503 例患者中的 92 例）。合并的优势比为 0.85（95%置信区间 0.35 至 2.05，p=0.72）。研究之间存在显著的异质性。总之，累积证据表明，超声心动图中使用造影剂是安全的，与心肌梗死发生率或死亡率增加无关。
