A Critical Review of Meta-Analysis of Adverse Events After Contrast Media

  • Giuseppe Biondi-Zoccai
  • Giacomo Frati
Part of the Medical Radiology book series (MEDRAD)


Systematic reviews provide a point of view on a specific clinical topic by using explicit and structured methods for study search, selection, appraisal, and data extraction. When data pooling is performed using ad hoc statistical methods, a systematic review may also be described as a meta-analysis, although this type of analysis would more appropriately be described as a systematic review with meta-analysis. Adverse events after contrast agent administration are an ideal topic for systematic reviews, as they are uncommon. Any single randomized trial is unlikely to be adequately powered to accurately assess the incidence of adverse events and to compare adverse event rates between treatment groups while at the same time focusing on clinically relevant (i.e., hard) end-points. This chapter provides a concise but comprehensive overview of systematic reviews and meta-analyses, with particular focus on their application to adverse events after contrast agent administration.


Systematic Review Contrast Agent Critical Limb Ischemia Contrast Agent Administration Beta Error 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Antithrombotic Trialists’ Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324:71–86CrossRefGoogle Scholar
  2. Aspelin P, Aubry P, Fransson SG et al (2003) Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 348:491–499PubMedCrossRefGoogle Scholar
  3. Barnes DE, Bero LA (1998) Why review articles on the health effects of passive smoking reach different conclusions. JAMA 297:1566–1570CrossRefGoogle Scholar
  4. Biondi-Zoccai G, Abbate A, Agostoni P et al (2005) Long-term benefits of an early invasive management in acute coronary syndromes depend on intracoronary stenting and aggressive antiplatelet treatment: a metaregression. Am Heart J 149:504–511PubMedCrossRefGoogle Scholar
  5. Biondi-Zoccai G, Agostoni P, Abbate A (2003) Parallel hierarchy of scientific studies in cardiovascular medicine. Ital Heart J 4:819–820PubMedGoogle Scholar
  6. Biondi-Zoccai G, Lotrionte M, Abbate A et al (2006) Compliance with QUOROM and quality of reporting of overlapping meta-analyses on the role of acetylcysteine in the prevention of contrast associated nephropathy: case study. BMJ 332:202–209PubMedCrossRefGoogle Scholar
  7. Biondi-Zoccai G, Lotrionte M, Anselmino M et al (2008) Systematic review and meta-analysis of randomized clinical trials appraising the impact of cilostazol after percutaneous coronary intervention. Am Heart J 155:1081–1089PubMedCrossRefGoogle Scholar
  8. Biondi-Zoccai G, Lotrionte M, Landoni G, Modena MG (2011) The rough guide to systematic reviews and meta-analyses. HSR Proc Intensive Care Cardiovasc Anesth 3:161–173PubMedCentralPubMedGoogle Scholar
  9. Biondi-Zoccai G, Testa L, Agostoni P (2004) A practical algorithm for systematic reviews in cardiovascular medicine. Ital Heart J 5:486–487PubMedGoogle Scholar
  10. Biondi-Zoccai GG, Abbate A, Sheiban I (2009) Systematic reviews and meta-analyses “For Dummies”. EuroIntervention 5:289–291PubMedCrossRefGoogle Scholar
  11. Bucher HC, Guyatt GH, Griffith LE, Walter SD (1997) The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol 50:683–691PubMedCrossRefGoogle Scholar
  12. Cappelleri JC, Ioannidis JP, Schmid CH et al (1996) Large trials vs meta-analysis of smaller trials: how do their results compare? JAMA 276:1332–1338PubMedCrossRefGoogle Scholar
  13. Chien PF, Khan KS, Siassakos D (2012) Registration of systematic reviews: PROSPERO. BJOG 119:903–905PubMedCrossRefGoogle Scholar
  14. Egger M, Smith GD, Altman DG (2001) Systematic reviews in health care: meta-analysis in context, 2nd edn. BMJ Publishing Group, LondonCrossRefGoogle Scholar
  15. Glass G (1976) Primary, secondary and meta-analysis of research. Educ Res 5:3–8Google Scholar
  16. Golder S, Loke Y, McIntosh HM (2006) Room for improvement? a survey of the methods used in systematic reviews of adverse effects. BMC Med Res Methodol 6:3PubMedCentralPubMedCrossRefGoogle Scholar
  17. Guyatt G, Rennie D, Meade M, Cook D (2002) Users’ guides to the medical literature. A manual for evidence-based clinical practice. AMA Press, ChicagoGoogle Scholar
  18. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRefGoogle Scholar
  19. Higgins JPT, Green S (2008) Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration, OxfordCrossRefGoogle Scholar
  20. Kandzari DE, Roe MT, Chen AY et al (2005) Influence of clinical trial enrollment on the quality of care and outcomes for patients with non-ST-segment elevation acute coronary syndromes. Am Heart J 149:474–481PubMedCrossRefGoogle Scholar
  21. Kwok CS, Pang CL, Yeong JK, Loke YK (2013) Measures used to treat contrast-induced nephropathy: overview of reviews. Br J Radiol 86:20120272PubMedCrossRefGoogle Scholar
  22. Lau J, Ioannidis JP, Schmid CH (1998) Summing up evidence: one answer is not always enough. Lancet 351:123–127PubMedCrossRefGoogle Scholar
  23. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700PubMedCentralPubMedCrossRefGoogle Scholar
  24. Lu G, Ades AE (2004) Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med 23:3105–3124PubMedCrossRefGoogle Scholar
  25. Lumley T (2002) Network meta-analysis for indirect treatment comparisons. Stat Med 21:2313–2324PubMedCrossRefGoogle Scholar
  26. Moher D, Cook DJ, Eastwood S et al (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUORUM statement. Lancet 354:1896–1900PubMedCrossRefGoogle Scholar
  27. Palmerini T, Biondi-Zoccai G, Della Riva D et al (2012) Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. Lancet 379:1393–1402PubMedCrossRefGoogle Scholar
  28. Peters JL, Sutton AJ, Jones DR et al (2006) Comparison of two methods to detect publication bias in meta-analysis. JAMA 295:676–680PubMedCrossRefGoogle Scholar
  29. Shea BJ, Bouter LM, Peterson J et al (2007) External validation of a measurement tool to assess systematic reviews (AMSTAR). PLoS ONE 2(12):e1350PubMedCentralPubMedCrossRefGoogle Scholar
  30. Solomon RJ, Natarajan MK, Doucet S et al (2007) Cardiac angiography in renally impaired patients (CARE) study: a randomized double-blind trial of contrast-induced nephropathy in patients with chronic kidney disease. Circulation 115:3189–3196PubMedCrossRefGoogle Scholar
  31. Sweeting MJ, Sutton AJ, Lambert PC (2004) What to add to nothing? Use and avoidance of continuity corrections in meta-analysis of sparse data. Stat Med 23:1351–1375PubMedCrossRefGoogle Scholar
  32. Thompson SG, Higgins JP (2002) How should meta-regression analyses undertaken and interpreted? Stat Med 21:1559–1573PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of Medico-Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
  2. 2.Department of Medico-Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly

Personalised recommendations