| Background Recombinant human brain natriuretic peptide has been shown to provide symptomatic and hemodynamic improvement in heart failure. Its short-term and long-term safety is less clear.Objective We performed a meta-analysis to evaluate the short- and long-term risk of death with rhBNP in the treatment of decompensated heart failure.Methods We searched PubMed(1966——2009.2),ClinicalTrials.gov(http://www.clinicaltrials.gov/ct2/home);China Biologieal Medieine Databas(CBM,1979——2009.2)。Searched for studies according to the search strategy of randomized controlled trial,nesiritide or Recombinant human brain natriuretic peptide,heart failure . RCTs on rhBNP with available data on 30-day or 180-day mortality were included. Two reviewers extracted data and assessed trial quality independently. The RevMan4.3.10 software was used for summarizing all the studies, calculating the pooled RR and its 95%CI, and testing the overall effects. The funnel plot and Egger's test were performed for evaluating the publication bias.The sensitivity analysis by different effect model and sample size was employed for the reliability of meta-analysis.Results Ten large randomized controlled trials on rhBNP with available data on 30-day mortality were included. Data on 180-day mortality were available only in 6 trials. The pooled estimate of the relative risks (RR) for unadjusted 30- and 180-day mortality revealed no significant differences between the nesiritide arm (RR 1.243, 95% CI 0.798-1.935; RR0.98,95%CI 0.81-1.19) and control arm. The results of publication bias diagnostics and sensitivity analysis accounted for the reliability and stability of this Meta-analysis.Conclusions Our meta-analysis indicates that nesiritide is not associated with a higher 30-day or 180-day mortality. Large-scale randomized controlled trials powered to evaluate mortality are required before routine use of nesiritide for decompensated heart failure. |
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