Zhang Bu-Chun, Wu Qiang, Wang Cheng, Li Dong-Ye, Wang Zhi-Rong
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical College, Jiangsu 221002, China.
Department of Cardiology, Xuzhou Central Hospital, Southeast University, Jiangsu 221009, China.
J Cardiol. 2014 Apr;63(4):260-8. doi: 10.1016/j.jjcc.2013.11.021. Epub 2014 Jan 4.
The iso-osmolar contrast agent iodixanol may be associated with a lower incidence of cardiac events than low-osmolar contrast media (LOCM), but previous trials have yielded mixed results.
To compare the risk of total cardiovascular events of the iso-osmolar contrast medium, iodixanol, to LOCM.
Medical literature databases were searched to identify comparisons between iodixanol and LOCM with cardiovascular events as a primary endpoint. A random-effects model was used to obtain pooled odds ratio (OR) for within-hospital and 30-day events.
A total of 2 prospective cross-sectional studies and 11 randomized controlled trials (RCTs) (covering 6859 subjects) met our criteria. There was no significant difference in the incidence of within-hospital and 30-day cardiovascular events when iodixanol was compared with LOCM, with pooled OR of 0.72 (95%CI 0.49-1.06, p=0.09) and 1.19 (95%CI 0.70-2.02, p=0.53), respectively. Subgroup analysis showed no relative difference when iodixanol was compared with ioxaglate (OR=0.92, 95%CI 0.50-1.70, p=0.80) and iohexol (OR=0.75, 95%CI 0.48-1.17, p=0.21). However, a reduction in the within-hospital cardiovascular events was observed when iodixanol was compared with LOCM in the RCT subgroup (OR=0.65, 95%CI 0.44-0.96, p=0.03). Sensitivity analyses revealed that three studies had a strong impact on the association of within-hospital cardiovascular events between iodixanol and LOCM. Meta-regression analysis failed to account for heterogeneity. No publication bias was detected.
This meta-analysis demonstrates that there is no conclusive evidence that iodixanol is superior to LOCM overall with regard to fewer cardiovascular events.
等渗造影剂碘克沙醇与心脏事件发生率低于低渗造影剂（LOCM）可能相关，但既往试验结果不一。
比较等渗造影剂碘克沙醇与低渗造影剂发生总体心血管事件的风险。
检索医学文献数据库，以心血管事件作为主要终点，确定碘克沙醇与低渗造影剂之间的比较。采用随机效应模型获得院内和30天事件的合并比值比（OR）。
共有2项前瞻性横断面研究和11项随机对照试验（RCT）（涵盖6859名受试者）符合我们的标准。将碘克沙醇与低渗造影剂比较时，院内和30天心血管事件的发生率无显著差异，合并OR分别为0.72（95%CI 0.49 - 1.06，p = 0.09）和1.19（95%CI 0.70 - 2.02，p = 0.53）。亚组分析显示，将碘克沙醇与碘克酸（OR = 0.92，95%CI 0.50 - 1.70，p = 0.80）和碘海醇（OR = 0.75，95%CI 0.48 - 1.17，p = 0.21）比较时，无相对差异。然而，在RCT亚组中，将碘克沙醇与低渗造影剂比较时，观察到院内心血管事件有所减少（OR = 0.65，95%CI 0.44 - 0.96，p = 0.03）。敏感性分析显示，三项研究对碘克沙醇与低渗造影剂之间的院内心血管事件关联有强烈影响。Meta回归分析未能解释异质性。未检测到发表偏倚。
这项Meta分析表明，没有确凿证据表明碘克沙醇在减少心血管事件方面总体上优于低渗造影剂。
