{"title":"SGLT2 抑制剂对 2 型糖尿病导管消融术后心房颤动复发的影响：利用试验序列分析重建卡普兰-梅耶曲线的 Meta 分析。","authors":"Youssef Soliman, Mohamed Abuelazm, Basma Ehab Amer, Mishaal Hukamdad, Mohamed Hatem Ellabban, Nada Ibrahim Hendi, Adel Mouffokes, Basel AbdelAzeem, Hatem Hassaballa","doi":"10.1007/s40256-024-00661-5","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in managing cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is evolving. This meta-analysis seeks to explore the influence of SGLT2i on the recurrence of atrial fibrillation (AF) following catheter ablation (CA) in individuals with T2DM qualitatively and quantitatively.</p><h3>Methods</h3><p>A comprehensive literature search was conducted in electronic databases. Studies meeting predefined criteria were included. Individual patient data (IPD) were used from reconstructed time-to-event data to estimate hazard ratios (HRs) and 95% confidence intervals for AF recurrence. IPD meta-analysis was followed by a direct meta-analysis to assess the risk of AF recurrence.</p><h3>Results</h3><p>A total of five studies [one randomized controlled trial (RCT) and four cohort studies] were included in this study, and five studies were included in the qualitative analysis, while four studies comprising 1043 patients with T2DM were included in the quantitative analysis. The pooled Kaplan–Meier curve based on reconstructed data showed a significantly lower risk of AF recurrence in the SGLT2i group compared with all antidiabetic drugs (log-rank <i>P</i> = 0.00011) and dipeptidyl-peptidase IV inhibitors (DPP4i) (log-rank <i>P</i> = 0.01). Cox regression analysis showed consistent results. Direct meta-analysis showed that SGLT2i, compared with all antidiabetic medications (HR 0.57, 95% CI [0.44, 0.73], <i>I</i><sup>2</sup>) and DPP4i (HR 0.41, 95% CI [0.24, 0.70], <i>I</i><sup>2</sup>), was associated with a lower risk of AF recurrence.</p><h3>Conclusions</h3><p>SGLT2i are associated with a reduced risk of AF recurrence after CA in patients with T2DM. These results suggest that SGLT2i is promising in improving clinical outcomes for this population.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 5","pages":"629 - 640"},"PeriodicalIF":2.8000,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344729/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of SGLT2 Inhibitors on Atrial Fibrillation Recurrence after Catheter Ablation in Type 2 Diabetes Mellitus: A Meta-Analysis of Reconstructed Kaplan–Meier Curves with Trial Sequential Analysis\",\"authors\":\"Youssef Soliman, Mohamed Abuelazm, Basma Ehab Amer, Mishaal Hukamdad, Mohamed Hatem Ellabban, Nada Ibrahim Hendi, Adel Mouffokes, Basel AbdelAzeem, Hatem Hassaballa\",\"doi\":\"10.1007/s40256-024-00661-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in managing cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is evolving. This meta-analysis seeks to explore the influence of SGLT2i on the recurrence of atrial fibrillation (AF) following catheter ablation (CA) in individuals with T2DM qualitatively and quantitatively.</p><h3>Methods</h3><p>A comprehensive literature search was conducted in electronic databases. Studies meeting predefined criteria were included. Individual patient data (IPD) were used from reconstructed time-to-event data to estimate hazard ratios (HRs) and 95% confidence intervals for AF recurrence. IPD meta-analysis was followed by a direct meta-analysis to assess the risk of AF recurrence.</p><h3>Results</h3><p>A total of five studies [one randomized controlled trial (RCT) and four cohort studies] were included in this study, and five studies were included in the qualitative analysis, while four studies comprising 1043 patients with T2DM were included in the quantitative analysis. The pooled Kaplan–Meier curve based on reconstructed data showed a significantly lower risk of AF recurrence in the SGLT2i group compared with all antidiabetic drugs (log-rank <i>P</i> = 0.00011) and dipeptidyl-peptidase IV inhibitors (DPP4i) (log-rank <i>P</i> = 0.01). Cox regression analysis showed consistent results. Direct meta-analysis showed that SGLT2i, compared with all antidiabetic medications (HR 0.57, 95% CI [0.44, 0.73], <i>I</i><sup>2</sup>) and DPP4i (HR 0.41, 95% CI [0.24, 0.70], <i>I</i><sup>2</sup>), was associated with a lower risk of AF recurrence.</p><h3>Conclusions</h3><p>SGLT2i are associated with a reduced risk of AF recurrence after CA in patients with T2DM. These results suggest that SGLT2i is promising in improving clinical outcomes for this population.</p></div>\",\"PeriodicalId\":7652,\"journal\":{\"name\":\"American Journal of Cardiovascular Drugs\",\"volume\":\"24 5\",\"pages\":\"629 - 640\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-07-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344729/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Cardiovascular Drugs\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://link.springer.com/article/10.1007/s40256-024-00661-5\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiovascular Drugs","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s40256-024-00661-5","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
目的：钠-葡萄糖共转运体 2 抑制剂（SGLT2i）在控制 2 型糖尿病（T2DM）患者心血管预后方面的作用正在不断发展。本荟萃分析旨在定性和定量地探讨 SGLT2i 对 T2DM 患者导管消融（CA）后房颤（AF）复发的影响：在电子数据库中进行了全面的文献检索。方法：在电子数据库中进行了全面的文献检索，纳入了符合预定标准的研究。利用重建的时间到事件数据中的患者个体数据（IPD）估算房颤复发的危险比（HRs）和 95% 置信区间。IPD荟萃分析之后进行直接荟萃分析，以评估房颤复发的风险：本研究共纳入了五项研究（一项随机对照试验（RCT）和四项队列研究），其中五项纳入了定性分析，四项纳入了定量分析，共包括 1043 名 T2DM 患者。基于重建数据的Kaplan-Meier曲线显示，与所有抗糖尿病药物（log-rank P = 0.00011）和二肽基肽酶IV抑制剂（DPP4i）（log-rank P = 0.01）相比，SGLT2i组房颤复发风险显著降低。Cox 回归分析显示了一致的结果。直接荟萃分析显示，与所有抗糖尿病药物（HR 0.57，95% CI [0.44，0.73]，I2）和 DPP4i（HR 0.41，95% CI [0.24，0.70]，I2）相比，SGLT2i 与较低的房颤复发风险相关：结论：SGLT2i 与 T2DM 患者 CA 后房颤复发风险降低有关。这些结果表明，SGLT2i 有望改善这一人群的临床预后。
Impact of SGLT2 Inhibitors on Atrial Fibrillation Recurrence after Catheter Ablation in Type 2 Diabetes Mellitus: A Meta-Analysis of Reconstructed Kaplan–Meier Curves with Trial Sequential Analysis
Purpose
The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in managing cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is evolving. This meta-analysis seeks to explore the influence of SGLT2i on the recurrence of atrial fibrillation (AF) following catheter ablation (CA) in individuals with T2DM qualitatively and quantitatively.
Methods
A comprehensive literature search was conducted in electronic databases. Studies meeting predefined criteria were included. Individual patient data (IPD) were used from reconstructed time-to-event data to estimate hazard ratios (HRs) and 95% confidence intervals for AF recurrence. IPD meta-analysis was followed by a direct meta-analysis to assess the risk of AF recurrence.
Results
A total of five studies [one randomized controlled trial (RCT) and four cohort studies] were included in this study, and five studies were included in the qualitative analysis, while four studies comprising 1043 patients with T2DM were included in the quantitative analysis. The pooled Kaplan–Meier curve based on reconstructed data showed a significantly lower risk of AF recurrence in the SGLT2i group compared with all antidiabetic drugs (log-rank P = 0.00011) and dipeptidyl-peptidase IV inhibitors (DPP4i) (log-rank P = 0.01). Cox regression analysis showed consistent results. Direct meta-analysis showed that SGLT2i, compared with all antidiabetic medications (HR 0.57, 95% CI [0.44, 0.73], I2) and DPP4i (HR 0.41, 95% CI [0.24, 0.70], I2), was associated with a lower risk of AF recurrence.
Conclusions
SGLT2i are associated with a reduced risk of AF recurrence after CA in patients with T2DM. These results suggest that SGLT2i is promising in improving clinical outcomes for this population.
期刊介绍：
Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents.
Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations.
The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.
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