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Effects of intravenous hydration on risk of contrast induced nephropathy and in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials

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journal contribution
posted on 2019-12-01, 00:00 authored by Yong Liu, Daqing Hong, Amanda Ying Wang, Rui Guo, Brendan Smyth, Jin Liu, Guoli Sun, Shiqun Chen, Ning Tan, Meg Jardine, David Brieger, Ahmed Shaman, Shariful IslamShariful Islam, Jiyan Chen, Martin Gallagher
Background
The role of intravenous hydration at the time of primary percutaneous intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains unclear. Guidelines are vague, supported by low level evidence, and hydration is used less often than other clinical settings.To perform a systematic review and meta-analysis of all randomized controlled trials assessing intravenous hydration compared with non-hydration for prevention of contrast induced nephropathy (CIN) and In-hospital mortality in patients with STEMI undergoing primary PCI.

Methods
Medline, EMBASE and the Cochrane Register were searched to September 2018. Included studies reported the incidence of CIN, In-hospital mortality, requirement for dialysis and heart failure. Relative risks with 95% confidence intervals (CIs) for individual trials were pooled using a random effects model.

Results
Three moderate quality trials were identified including 1074 patients. Overall, compared with no hydration, intravenous hydration significantly reduced the incidence of CIN by 42% (RR 0.58; 95% CI: 0.45 to 0.74, p < 0.001). The estimated effects upon all-cause mortality (RR 0.56; 95% CI: 0.30 to 1.02, p = 0.057) and the requirement for dialysis (RR 0.52, 95% CI 0.14–1.88, p = 0.462) were not statistically significant. The outcome of heart failure was not consistently reported.

Conclusions
Intravenous hydration likely reduces the incidence of CIN in patients with STEMI undergoing primary PCI. However, for key clinical outcomes such as mortality, heart failure and dialysis the effect estimates were imprecise. Further high quality studies are needed to clarify the appropriate volume of fluid and effects on outcomes.

History

Journal

BMC cardiovascular disorders

Volume

19

Article number

87

Pagination

1 - 9

Publisher

BioMed Central

Location

London, Eng.

eISSN

1471-2261

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2019, The Author(s)