Cardiovascular and all-cause mortality outcomes of adrenalectomy versus medical treatment in primary aldosteronism: an umbrella review.

IF 12.5 2区 医学 Q1 SURGERY
Sandeep Samethadka Nayak, Ehsan Amini-Salehi, Farahnaz Joukar, Pubali Biswas, Sara Nobakht, Negin Letafatkar, Parham Porteghali, Erfan Mohammadi-Vajari, Fariborz Mansour-Ghanaei, Mona Javid, Arian Mirdamadi, Daniyal Ameen, Behrang Motamed, Soheil Hassanipour, Mohammad-Hossein Keivanlou
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引用次数: 0

Abstract

Background: Primary aldosteronism (PA) is now recognized as the most prevalent form of secondary hypertension globally, contributing significantly to cardiovascular morbidity and mortality. This umbrella review aims to systematically compare cardiovascular outcomes and all-cause mortality in PA patients undergoing adrenalectomy versus mineralocorticoid receptor antagonist (MRA) treatment, aiming to inform optimal management strategies.

Method: Following PRISMA guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/D386, Supplemental Digital Content 2, http://links.lww.com/JS9/D387, a comprehensive search strategy was employed across multiple databases. Meta-analyses focusing on cardiovascular outcomes or all-cause mortality, comparing adrenalectomy and MRAs treatment in PA patients, were included. Studies were independently screened and assessed for quality using AMSTAR 2, Supplemental Digital Content 3, http://links.lww.com/JS9/D388 and GRADE checklists.

Results: A total of 8 studies met the inclusion criteria. Adrenalectomy showed potential benefits over MRAs in reducing the risk of arrhythmias (OR=2.17; 95% CI: 1.25-3.76) and major adverse cardiovascular events (OR=1.81; 95% CI: 1.33-2.46). Patients treated with MRAs exhibited a higher risk of cardiovascular events (OR=1.23; 95% CI: 1.05-1.44), hypertension (OR=3.22; 95% CI: 1.15-8.97), and all-cause mortality (OR=3.03; 95% CI: 1.36-6.70) compared to adrenalectomy.

Conclusion: Adrenalectomy appears to offer favorable outcomes compared to MRAs treatment in PA patients, particularly in reducing the risk of major adverse cardiovascular events and all-cause mortality. These findings suggest the importance of considering surgical intervention as a primary treatment modality for PA.

肾上腺切除术与药物治疗对原发性醛固酮增多症的心血管和全因死亡率的影响:综述。
背景:原发性醛固酮增多症(PA)目前被认为是全球最普遍的继发性高血压,对心血管疾病的发病率和死亡率有重大影响。本综述旨在系统比较接受肾上腺切除术与矿皮质激素受体拮抗剂(MRA)治疗的 PA 患者的心血管预后和全因死亡率,旨在为最佳管理策略提供参考:按照 PRISMA 指南(补充数字内容 1,http://links.lww.com/JS9/D386)和补充数字内容 2(http://links.lww.com/JS9/D387),在多个数据库中采用了全面的检索策略。纳入了以心血管预后或全因死亡率为重点、比较 PA 患者肾上腺切除术和 MRAs 治疗的 Meta 分析。采用 AMSTAR 2、Supplemental Digital Content 3、http://links.lww.com/JS9/D388 和 GRADE 检查表对研究进行独立筛选和质量评估:结果:共有 8 项研究符合纳入标准。肾上腺切除术在降低心律失常风险(OR=2.17;95% CI:1.25-3.76)和主要不良心血管事件(OR=1.81;95% CI:1.33-2.46)方面比 MRAs 有潜在优势。与肾上腺切除术相比,接受MRA治疗的患者发生心血管事件(OR=1.23;95% CI:1.05-1.44)、高血压(OR=3.22;95% CI:1.15-8.97)和全因死亡率(OR=3.03;95% CI:1.36-6.70)的风险更高:结论:与 MRAs 治疗相比,肾上腺切除术似乎能为 PA 患者带来更好的治疗效果,尤其是在降低主要不良心血管事件和全因死亡率风险方面。这些研究结果表明,将外科干预作为 PA 的主要治疗方式具有重要意义。
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来源期刊
CiteScore
17.70
自引率
3.30%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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