SGLT2 抑制剂对 2 型糖尿病患者导管消融后心房颤动复发的影响：基于试验序贯分析的重建 Kaplan-Meier 曲线的荟萃分析。

Impact of SGLT2 Inhibitors on Atrial Fibrillation Recurrence after Catheter Ablation in Type 2 Diabetes Mellitus: A Meta-Analysis of Reconstructed Kaplan-Meier Curves with Trial Sequential Analysis.

机构信息

Faculty of Medicine, Assiut University, Assiut, Egypt.

Faculty of Medicine, Tanta University, Tanta, Egypt.

出版信息

Am J Cardiovasc Drugs. 2024 Sep;24(5):629-640. doi: 10.1007/s40256-024-00661-5. Epub 2024 Jul 4.

DOI:10.1007/s40256-024-00661-5

PMID:38963527

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11344729/

Abstract

PURPOSE

The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in managing cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is evolving. This meta-analysis seeks to explore the influence of SGLT2i on the recurrence of atrial fibrillation (AF) following catheter ablation (CA) in individuals with T2DM qualitatively and quantitatively.

METHODS

A comprehensive literature search was conducted in electronic databases. Studies meeting predefined criteria were included. Individual patient data (IPD) were used from reconstructed time-to-event data to estimate hazard ratios (HRs) and 95% confidence intervals for AF recurrence. IPD meta-analysis was followed by a direct meta-analysis to assess the risk of AF recurrence.

RESULTS

A total of five studies [one randomized controlled trial (RCT) and four cohort studies] were included in this study, and five studies were included in the qualitative analysis, while four studies comprising 1043 patients with T2DM were included in the quantitative analysis. The pooled Kaplan-Meier curve based on reconstructed data showed a significantly lower risk of AF recurrence in the SGLT2i group compared with all antidiabetic drugs (log-rank P = 0.00011) and dipeptidyl-peptidase IV inhibitors (DPP4i) (log-rank P = 0.01). Cox regression analysis showed consistent results. Direct meta-analysis showed that SGLT2i, compared with all antidiabetic medications (HR 0.57, 95% CI [0.44, 0.73], I) and DPP4i (HR 0.41, 95% CI [0.24, 0.70], I), was associated with a lower risk of AF recurrence.

CONCLUSIONS

SGLT2i are associated with a reduced risk of AF recurrence after CA in patients with T2DM. These results suggest that SGLT2i is promising in improving clinical outcomes for this population.

摘要

目的

钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）在管理 2 型糖尿病（T2DM）患者心血管结局方面的作用正在不断发展。本荟萃分析旨在定性和定量探讨 SGLT2i 对 T2DM 患者经导管消融（CA）后心房颤动（AF）复发的影响。

方法

对电子数据库进行全面文献检索。纳入符合预设标准的研究。使用个体患者数据（IPD）从重建的生存时间数据中估计 HR 和 95%置信区间，以评估 AF 复发的风险。进行 IPD 荟萃分析后，进行直接荟萃分析以评估 AF 复发的风险。

结果

本研究共纳入 5 项研究[1 项随机对照试验（RCT）和 4 项队列研究]，其中 5 项研究纳入定性分析，4 项研究纳入包括 1043 例 T2DM 患者的定量分析。基于重建数据的 Kaplan-Meier 曲线显示，SGLT2i 组的 AF 复发风险明显低于所有抗糖尿病药物（对数秩 P=0.00011）和二肽基肽酶 4 抑制剂（DPP4i）（对数秩 P=0.01）。Cox 回归分析得到了一致的结果。直接荟萃分析显示，与所有抗糖尿病药物（HR 0.57，95%CI [0.44, 0.73]，I）和 DPP4i（HR 0.41，95%CI [0.24, 0.70]，I）相比，SGLT2i 与 AF 复发风险降低相关。