Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Am J Cardiol. 2019 Mar 1;123(5):820-826. doi: 10.1016/j.amjcard.2018.11.030. Epub 2018 Dec 11.
We performed a meta-analysis of currently available studies investigating impact of baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) on mortality after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). MEDLINE and EMBASE were searched through August 2018 using PubMed and OVID. Studies considered for inclusion met the following criteria: the design was a study researching impact of baseline NT-proBNP levels on survival; the study population was patients underwent TAVI for AS; outcomes included all-cause mortality. For each study, we directly extracted odds ratio (ORs) or hazard ratios (HRs) of mortality (for high vs low baseline NT-proBNP); and generated ORs using mortality rates in both patients with high and low levels of baseline NT-proBNP. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. We identified 16 eligible studies including a total of 3,679 patients who underwent TAVI for AS. Pooled analyses demonstrated that high levels of baseline NT-proBNP were associated with a statistically nonsignificant increase in early (30-day or 2-month) mortality (pooled OR, 1.60; 95% confidence interval, 0.84 to 3.04; p = 0.15) and a statistically significant increase in midterm (6-month to 4-year) mortality (pooled OR/HR, 1.88; 95% confidence interval, 1.54 to 2.28; p < 0.00001). Although funnel-plot asymmetry suggesting publication bias was detected, adjusting for funnel-plot asymmetry indicated an association of high levels of baseline NT-proBNP with a still significant increase in midterm mortality. In conclusion, high levels of baseline NT-proBNP predict increased midterm, not early, mortality after TAVI for AS.
我们对目前研究的荟萃分析，调查了经导管主动脉瓣植入术（TAVI）治疗主动脉瓣狭窄（AS）后基线 N 末端脑钠肽前体（NT-proBNP）对死亡率的影响。通过 PubMed 和 OVID 检索了 MEDLINE 和 EMBASE，检索时间截至 2018 年 8 月。纳入的研究符合以下标准：设计为研究基线 NT-proBNP 水平对生存的影响；研究人群为接受 TAVI 治疗 AS 的患者；结局包括全因死亡率。对于每项研究，我们直接提取死亡率的比值比（OR）或风险比（HR）（高 vs 低基线 NT-proBNP）；并使用高和低基线 NT-proBNP 水平患者的死亡率生成 OR。使用随机效应模型中对数 OR/HR 的倒数方差加权平均值合并研究特异性估计值。我们确定了 16 项符合条件的研究，共纳入了 3679 名接受 TAVI 治疗 AS 的患者。汇总分析表明，基线 NT-proBNP 水平升高与早期（30 天或 2 个月）死亡率统计学上无显著增加相关（汇总 OR，1.60；95%置信区间，0.84 至 3.04；p=0.15），但与中期（6 个月至 4 年）死亡率统计学上显著增加相关（汇总 OR/HR，1.88；95%置信区间，1.54 至 2.28；p<0.00001）。尽管漏斗图表明存在发表偏倚的不对称性，但调整漏斗图不对称性表明，基线 NT-proBNP 水平升高与中期死亡率仍显著增加相关。总之，基线 NT-proBNP 水平升高预测 TAVI 治疗 AS 后中期而非早期死亡率增加。
