title: A meta-analysis of the risk of total cardiovascular events of isosmolar iodixanol compared with low-osmolar contrast media.
abstract: 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.
authors.affiliation: Department of Cardiology, The Affiliated Hospital of Xuzhou Medical College, Jiangsu 221002, China. Electronic address: zhangbc138@sina.com.cn.
authors.forename: Bu-Chun
authors.initials: BC
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Xuzhou Central Hospital, Southeast University, Jiangsu 221009, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Cardiology, The Affiliated Hospital of Xuzhou Medical College, Jiangsu 221002, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Cardiology, The Affiliated Hospital of Xuzhou Medical College, Jiangsu 221002, China.
authors.forename: Dong-Ye
authors.initials: DY
authors.lastname: Li
authors.affiliation: Department of Cardiology, The Affiliated Hospital of Xuzhou Medical College, Jiangsu 221002, China.
authors.forename: Zhi-Rong
authors.initials: ZR
authors.lastname: Wang
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology; D003287:Contrast Media / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007472:Iohexol / Q000009:adverse effects; D007485:Ioxaglic Acid / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012306:Risk; D013997:Time Factors; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C044834:iodixanol; D007485:Ioxaglic Acid
keywords: Cardiovascular disease; Iodixanol; Iso-osmolar contrast agent; Low-osmolar contrast agent; Meta-analysis