Proangiogenic Growth Factor Therapy for the Treatment of Refractory Angina: A Meta-analysis.

Autor:	Weeraman D; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.; Barts National Institute for Health and Care Research Biomedical Research Centre, Barts Heart Centre & Queen Mary University of London, London, United Kingdom.; Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom., Jones DA; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.; Barts National Institute for Health and Care Research Biomedical Research Centre, Barts Heart Centre & Queen Mary University of London, London, United Kingdom.; Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom., Hussain M; Barts National Institute for Health and Care Research Biomedical Research Centre, Barts Heart Centre & Queen Mary University of London, London, United Kingdom.; Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom., Beirne AM; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.; Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom., Hadyanto S; Barts National Institute for Health and Care Research Biomedical Research Centre, Barts Heart Centre & Queen Mary University of London, London, United Kingdom., Rathod KS; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.; Barts National Institute for Health and Care Research Biomedical Research Centre, Barts Heart Centre & Queen Mary University of London, London, United Kingdom.; Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom., Whiteford JR; Centre for Microvascular Research, William Harvey Research Institute, Barts & The London Medical School, Queen Mary University of London, London, United Kingdom., Reid AE; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom., Bourantas CV; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.; Barts National Institute for Health and Care Research Biomedical Research Centre, Barts Heart Centre & Queen Mary University of London, London, United Kingdom.; Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom., Ylä-Herttuala S; A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland., Baumbach A; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.; Barts National Institute for Health and Care Research Biomedical Research Centre, Barts Heart Centre & Queen Mary University of London, London, United Kingdom.; Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom., Gersh BJ; Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota., Henry TD; The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio., Mathur A; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.; Barts National Institute for Health and Care Research Biomedical Research Centre, Barts Heart Centre & Queen Mary University of London, London, United Kingdom.; Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Journal of the Society for Cardiovascular Angiography & Interventions [J Soc Cardiovasc Angiogr Interv] 2023 Jan 02; Vol. 2 (1), pp. 100527. Date of Electronic Publication: 2023 Jan 02 (Print Publication: 2023).
DOI:	10.1016/j.jscai.2022.100527
Abstrakt:	Background: Refractory angina (RFA; limiting angina despite optimal medical therapy) is a growing, global problem, with limited treatment options. Therefore, we conducted a systematic review of randomized controlled trials (RCTs) to evaluate the effect of proangiogenic growth factor therapy (in the form of vascular growth factors delivered either as recombinant proteins or gene therapy) in patients with RFA ineligible for revascularization. Methods: We performed a meta-analysis (PROSPERO: CRD42018107283) of RCTs as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A comprehensive search of the PubMed, CENTRAL, Embase, Cochrane, ClinicalTrials.gov and Google Scholar databases, as well as scientific session abstracts, were performed. The pooled outcomes included major adverse cardiac events (MACE), mortality, myocardial perfusion, and indices of angina severity (Canadian Cardiovascular Society angina class [CCS] and exercise tolerance). A prespecified subgroup analysis was performed for delivery method, vector, and protein type. The standardized mean difference (SMD) or odds ratio (OR) was calculated to assess relevant outcomes. We assessed heterogeneity using the χ 2 and I 2 tests. Results: We included 16 RCTs involving 1607 patients (1052 received proangiogenic growth factor therapy and 555 received a placebo or optimal medical therapy). Our analysis showed a significant decreased risk of MACE (OR, 0.72; 95% confidence interval [CI], 0.55-0.93) and significantly improved CCS class (SMD, -0.55; 95% CI, -1.10 to 0.00), but not mortality (OR, 0.66; 95% CI, 0.28-1.54) or exercise tolerance (SMD, 0.47; 95% CI, -0.14 to 1.09), in treated patients compared to those in the control group. Conclusions: Proangiogenic growth factor therapy is a promising treatment option for RFA, with beneficial effects seen on MACE and CCS class. The results of ongoing trials are needed before it can be considered for clinical practice. (© 2022 The Authors.)
Databáze:	MEDLINE
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