François Cossette, Alexandru Trifan, Gabriel Prévost-Marcotte, Gemina Doolub, Derek F So, William Beaubien-Souligny, Dana Abou-Saleh, Jean-Francois Tanguay, Brian J Potter, Hung Q Ly, Istok Menkovic, Tomas Cieza, Robert Avram, Alexandra Bastiany, Guillaume Marquis-Gravel
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引用次数: 0
Abstract
Background: Contrast-induced acute kidney injury (CI-AKI) is a frequent complication of coronary interventions associated with an increased risk of mortality and morbidity. The optimal intravenous hydration strategy to prevent CI-AKI is not well-established. The primary objective is to determine if a tailored hydration strategy reduces the risk of CI-AKI and of major adverse cardiovascular events (MACE) in patients undergoing coronary angiography compared with a non-tailored hydration strategy.
Methods: A study-level meta-analysis of randomized controlled trials comparing tailored versus non-tailored hydration strategies for the prevention of CI-AKI (primary outcome) and of MACE (main secondary outcome) in patients undergoing coronary angiography for any indication was performed. Tailored hydration was defined as the administration of intravenous fluids based on patient-specific parameters other than weight only.
Results: A total of 13 studies were included (n = 4,458 participants). The overall risk of bias was moderate. A tailored strategy was associated with a significant reduction in the risk of CI-AKI (RR=0.56, 95% CI, [0.46-0.69], p<0.00001; I2=26%), and of MACE (RR=0.57, 95% CI, [0.42-0.78], p=0.0005; I2=12%). A tailored hydration strategy was not associated with a significant reduction in the other pre-specified secondary outcomes, except for all-cause mortality (RR=0.57, 95% CI, [0.35, 0.94], p=0.03; I2=0%). The impact of a tailored strategy on the primary outcome was consistent in sensitivity analyses.
Conclusion: These results suggest that tailored hydration is superior to non-tailored hydration in reducing the risk of CI-AKI and MACE in patients undergoing coronary angiography. Future trials are required to identify the optimal tailored hydration strategy.
期刊介绍：
The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.
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