A meta-analysis of the risk of total cardiovascular events of isosmolar iodixanol compared with low-osmolar contrast media

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• 作者：Bu-Chun Zhang ; MD ; PhD^a ; ¹ ; ^{zhangbc138@sina.com.cn" class="auth_mail} ; Qiang Wu ; MD^b ; ¹ ; Cheng Wang ; MD^a ; Dong-Ye Li ; MD^a ; Zhi-Rong Wang ; MD^a
• 关键词：Cardiovascular disease ; Iodixanol ; Iso-osmolar contrast agent ; Low-osmolar contrast agent ; Meta-analysis
• 刊名：Journal of Cardiology
• 出版年：April, 2014
• 年：2014
• 卷：63
• 期：4
• 页码：260-268
• 全文大小：1534 K

文摘

Background

The iso-osmolar contrast agent iodixanol may be associated with a lower incidence of cardiac events than low-osmolar contrast media (LOCM), but previous trials have yielded mixed results.

Objective

To compare the risk of total cardiovascular events of the iso-osmolar contrast medium, iodixanol, to LOCM.

Methods

Medical literature databases were searched to identify comparisons between iodixanol and LOCM with cardiovascular events as a primary endpoint. A random-effects model was used to obtain pooled odds ratio (OR) for within-hospital and 30-day events.

Results

A total of 2 prospective cross-sectional studies and 11 randomized controlled trials (RCTs) (covering 6859 subjects) met our criteria. There was no significant difference in the incidence of within-hospital and 30-day cardiovascular events when iodixanol was compared with LOCM, with pooled OR of 0.72 (95%CI 0.49-1.06, p = 0.09) and 1.19 (95%CI 0.70-2.02, p = 0.53), respectively. Subgroup analysis showed no relative difference when iodixanol was compared with ioxaglate (OR = 0.92, 95%CI 0.50-1.70, p = 0.80) and iohexol (OR = 0.75, 95%CI 0.48-1.17, p = 0.21). However, a reduction in the within-hospital cardiovascular events was observed when iodixanol was compared with LOCM in the RCT subgroup (OR = 0.65, 95%CI 0.44-0.96, p = 0.03). Sensitivity analyses revealed that three studies had a strong impact on the association of within-hospital cardiovascular events between iodixanol and LOCM. Meta-regression analysis failed to account for heterogeneity. No publication bias was detected.

Conclusions

This meta-analysis demonstrates that there is no conclusive evidence that iodixanol is superior to LOCM overall with regard to fewer cardiovascular events.