Background

Studies regarding the predictive utility of the blood level of asymmetric dimethylarginine (ADMA) in patients with coronary artery disease (CAD) have yielded the conflicting findings. This meta-analysis sought to evaluate the prognostic value of blood ADMA level in CAD patients.

Methods

Potentially relevant studies were identified by searching PubMed and Embase database until August 12, 2020. Cohort studies evaluating the association of blood ADMA level with all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACEs) were included. A random effect model was applied to pool the multivariable-adjusted risk ratio (RR) and 95% confidence intervals (CI) for the highest versus lowest ADMA level.

Results

Data were retrieved from 11 studies enrolling a total of 9496 CAD patients. When compared the highest to the lowest ADMA level, the pooled RR was 2.10 (95% CI 1.46–3.02) for all-cause mortality, 2.49 (95% CI 1.34–4.65) for cardiovascular mortality, and 1.71 (95% CI 1.27–2.32) for MACEs, respectively. However, subgroup analysis showed that there were no significant association between elevated ADMA level and all-cause mortality in acute coronary syndrome (RR 2.11; 95% CI 0.93–4.78) and follow up ≤ 1 year (RR 2.15; 95% CI 0.56–8.25) subgroup.

Conclusions

Elevated blood ADMA level is possibly an independent predictor of all-cause mortality, cardiovascular mortality, and MACEs in CAD patients. Measurement of blood level of ADMA may improve risk classification of CAD. However, these findings should be interpreted with caution because of the limited number of studies included.

中文翻译：

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不对称二甲基精氨酸对冠心病患者预后价值的荟萃分析

背景

关于不对称二甲基精氨酸 (ADMA) 血液水平对冠状动脉疾病 (CAD) 患者的预测效用的研究得出了相互矛盾的发现。该荟萃分析旨在评估血液 ADMA 水平对 CAD 患者的预后价值。

方法

在 2020 年 8 月 12 日之前，通过搜索 PubMed 和 Embase 数据库确定了可能相关的研究。包括评估血液 ADMA 水平与全因死亡率、心血管死亡率和主要不良心血管事件 (MACE) 关联的队列研究。应用随机效应模型来合并最高与最低 ADMA 水平的多变量调整风险比 (RR) 和 95% 置信区间 (CI)。

结果

从 11 项研究中检索数据，共招募了 9496 名 CAD 患者。与最高和最低 ADMA 水平相比，全因死亡率的汇总 RR 为 2.10（95% CI 1.46-3.02），心血管死亡率为 2.49（95% CI 1.34-4.65）和 1.71（95% CI 1.27-） 2.32) 分别为 MACE。然而，亚组分析显示，ADMA 水平升高与急性冠脉综合征的全因死亡率（RR 2.11；95% CI 0.93-4.78）和随访 ≤ 1 年（RR 2.15；95% CI 0.56-）之间没有显着关联。 8.25) 子组。

结论

血液 ADMA 水平升高可能是 CAD 患者全因死亡率、心血管死亡率和 MACE 的独立预测因素。血液中 ADMA 水平的测量可能会改善 CAD 的风险分类。然而，由于纳入的研究数量有限，应谨慎解释这些发现。