Meta Analysis of Individual Patient Data of Sodium Bicarbonate and Sodium Chloride for All Cause Mortality After Coronary Angiography.
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.
The American journal of cardiology