Safety and efficacy of soluble guanylate cyclase stimulators in patients with heart failure: A systematic review and meta-analysis

作     者：Waqas Ullah Maryam Mukhtar Aws Al-Mukhtar Rehan Saeed Margot Boigon Donald Haas Eduardo Rame 

作者机构：Department of Internal MedicineAbington Jefferson HealthAbingtonPA 19001United States Department of CardiologyRawalpindi Institute of CardiologyRawalpindi 44000PunjabPakistan Department of Surgery and CancerImperial College LondonLondon SW72AZUnited Kingdom Department of CardiologyThomas Jefferson UniversityPhiladelphiaPA 19001United States 

出 版 物：《World Journal of Cardiology》 (世界心脏病学杂志（英文版）（电子版）)

年 卷 期：2020年第12卷第10期

页      面：501-512页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Vericiguat Riociguat Soluble guanylate cyclase Heart failure Guanylate cyclase stimulator 

摘      要：BACKGROUND The utility of novel oral soluble guanylate cyclase(sGC)stimulators(vericiguat and riociguat),in patients with reduced or preserved ejection fraction heart failure(HFrEF/HFpEF)is currently *** To determine the efficacy and safety of sGC stimulators in HF *** Multiple databases were searched to identify relevant randomized controlled trials(RCTs).Data on the safety and efficacy of sGC stimulators were compared using relative risk ratio(RR)on a random effect *** Six RCTs,comprising 5604 patients(2801 in sGC stimulator group and 2803 placebo group)were *** primary endpoint(a composite of cardiovascular mortality and first HF-related hospitalization)was significantly reduced in patients receiving sGC stimulators compared to placebo[RR 0.92,95%confidence interval(CI):0.85-0.99,P=0.02].The incidence of total HF-related hospitalizations were also lower in sGC group(RR 0.91,95%CI:0.86-0.96,P=0.0009),however,sGC stimulators had no impact on all-cause mortality(RR 0.96,95%CI:0.86-1.07,P=0.45)or cardiovascular mortality(RR 0.94,95%CI:0.83-1.06,P=0.29).The overall safety endpoint(a composite of hypotension and syncope)was also similar between the two groups(RR 1.50,95%CI:0.93-2.42,P=0.10).By contrast,a stratified subgroup analysis adjusted by type of sGC stimulator and HF(vericiguat vs riociguat and HFrEF vs HFpEF)showed near identical rates for all safety and efficacy endpoints between the two groups at a mean follow-up of 19 *** the primary composite endpoint,the number needed to treat was 35,the number needed to harm was *** The use of vericiguat and riociguat in conjunction with standard HF therapy,shows no benefit in terms of decreasing HF-related hospitalizations or mortality.