title: Meta-Analysis of Individual Patient Data of Sodium Bicarbonate and Sodium Chloride for All-Cause Mortality After Coronary Angiography.
abstract: We sought to examine the relation between sodium bicarbonate prophylaxis for contrast-associated nephropathy (CAN) and mortality. We conducted an individual patient data meta-analysis from multiple randomized controlled trials. We obtained individual patient data sets for 7 of 10 eligible trials (2,292 of 2,764 participants). For the remaining 3 trials, time-to-event data were imputed based on follow-up periods described in their original reports. We included all trials that compared periprocedural intravenous sodium bicarbonate to periprocedural intravenous sodium chloride in patients undergoing coronary angiography or other intra-arterial interventions. Included trials were determined by consensus according to predefined eligibility criteria. The primary outcome was all-cause mortality hazard, defined as time from randomization to death. In 10 trials with a total of 2,764 participants, sodium bicarbonate was associated with lower mortality hazard than sodium chloride at 1 year (hazard ratio 0.61, 95% confidence interval [CI] 0.41 to 0.89, p = 0.011). Although periprocedural sodium bicarbonate was associated with a reduction in the incidence of CAN (relative risk 0.75, 95% CI 0.62 to 0.91, p = 0.003), there exists a statistically significant interaction between the effect on mortality and the occurrence of CAN (hazard ratio 5.65, 95% CI 3.58 to 8.92, p <0.001) for up to 1-year mortality. Periprocedural intravenous sodium bicarbonate seems to be associated with a reduction in long-term mortality in patients undergoing coronary angiography or other intra-arterial interventions.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Medicine, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Community and Family Medicine, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Electronic address: jbrown@dartmouth.edu.
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Pearlman
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Marshall
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Shama S
authors.initials: SS
authors.lastname: Alam
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Medicine, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Community and Family Medicine, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Todd A
authors.initials: TA
authors.lastname: MacKenzie
authors.affiliation: Department of Cardiology, Virgen Macarena University Hospital, Seville, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Recio-Mayoral
authors.affiliation: Hospital São Lucas, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Vitor O
authors.initials: VO
authors.lastname: Gomes
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Bokyung
authors.initials: B
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Lisette O
authors.initials: LO
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Maioli
authors.affiliation: Fletcher Allen Health Care, University of Vermont School of Medicine, Burlington, Vermont.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Solomon
mesh_terms: D002423:Cause of Death / Q000639:trends; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality; D014943:Global Health; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D012965:Sodium Chloride / Q000008:administration & dosage*; D015996:Survival Rate / Q000639:trends
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate