背景:关于原位心脏移植(OHT)前使用胺碘酮与OHT后移植物功能障碍(GD)之间的关联,导致临床实践中的异质性,存在矛盾的数据。
方法:我们进行了一项荟萃分析,以评估OHT前使用胺碘酮是否与GD发病率的有意义增加有关,30天死亡率,和1年死亡率。通过搜索PubMed和Cochrane临床试验注册来确定研究。使用Mantel-Haenszel方法计算每个终点的比值比(OR)和95%置信区间(CI95)。
结果:确定了17项回顾性研究,包括48,782例患者。14项研究(n=48,018)报告了GD作为结果。OHT前使用胺碘酮与GD几率增加相关(OR1.3,CI951.2-1.5,p<0.001)。10项研究(n=45,875)报告了基于胺碘酮使用的30天死亡率。OHT前使用胺碘酮与30天死亡率增加相关(OR1.4,CI951.2-1.5,p<0.001)。5项研究(n=41,404)报告了基于胺碘酮使用的1年死亡率。OHT前使用胺碘酮与1年死亡率增加相关(OR1.2,CI951.1-1.4,p<0.001)。GD绝对风险的增加,30天死亡率,使用胺碘酮前OHT患者的1年死亡率为1.3%,1.2%,和1.4%,分别。
结论:Pre-OHT胺碘酮暴露与GD几率增加相关,30天死亡率,和1年死亡率。每个终点的绝对风险增加是适度的,目前还不清楚到什么程度,如果有的话,OHT前使用胺碘酮会影响OHT候选资格的评估.
BACKGROUND: There is conflicting data on the association between pre-orthotopic heart transplant (OHT) amiodarone use and post-OHT graft dysfunction (GD) leading to heterogeneity in clinical practice.
METHODS: We performed a meta-analysis to evaluate whether pre-OHT amiodarone use was associated with meaningful increases in the incidence of GD, 30-day mortality, and 1-year mortality. Studies were identified by searching PubMed and the Cochrane Register of Clinical Trials. The Mantel-Haenszel method was used to calculate odds ratios (OR) and 95% confidence intervals (CI95) for each endpoint.
RESULTS: 17 retrospective studies were identified that included 48,782 patients. 14 studies (n = 48,018) reported GD as an outcome. Pre-OHT amiodarone use was associated with increased odds of GD (OR 1.3, CI95 1.2-1.5, p < 0.001). 10 studies (n = 45,875) reported 30-day mortality based on amiodarone use. Pre-OHT amiodarone use was associated with increased odds of 30-day mortality (OR 1.4, CI95 1.2-1.5, p < 0.001). 5 studies (n = 41,404) reported 1-year mortality based on amiodarone use. Pre-OHT amiodarone use was associated with increased odds of 1-year mortality (OR 1.2, CI95 1.1-1.4, p < 0.001). The increase in absolute risk of GD, 30-day mortality, and 1-year mortality for patients with pre-OHT amiodarone use was 1.3%, 1.2%, and 1.4%, respectively.
CONCLUSIONS: Pre-OHT amiodarone exposure was associated with increased odds of GD, 30-day mortality, and 1-year mortality. The increase in absolute risk for each endpoint was modest, and it is unclear to what extent, if any, pre-OHT amiodarone use should influence assessment of OHT candidacy.