Effect of cardiac shock wave therapy for rehospitalization in patients with severe coronary artery disease: a meta-analysis and trial sequential analysis

Objective: We have previously demonstrated that cardiac shock wave therapy (CSWT) effectively improves myocardial ischemia in patients with severe coronary artery disease. In this study, we further addressed the efficacy and safety of CSWT in patients with severe coronary artery disease (SCAD) or refractory angina (RA). Methods: We undertook a meta-analysis of randomized clinical trials (RCTs) and prospective cohort studies identified in systematic searches of MEDLINE, EMBASE, the Cochrane Database, and Chinese SinoMed Database. Primary endpoint was the rate of major adverse cardiac events (MACE, the composite outcome of mortality, coronary artery revascularization, and rehospitalization). Required information size (RIS) was calculated with trial sequential analysis (TSA). Results: A total of 14 RCTs and 5 prospective cohort studies involving 1172 patients with a mean follow-up of 10.6 months (range 3–72) months were included. Overall, CSWT significantly decreased the rate of MACE compared with the control group (RR, 0.39; 95%CI, 0.29–0.53), which was mainly attributed to markedly lower risk of rehospitalization in the CSWT group (RR, 0.37; 95% CI, 0.27–0.51). Subgroup analysis showed that the pooled RR in studies enrolling patients with higher CCS (≥2.4) (RR, 0.36; 95% CI, 0.26–0.50) was significantly lower than that in studies enrolling patients with lower CCS (<2.4) (RR, 0.58; 95% CI, 0.29–1.16). TSA showed that The RIS for MACE was 935, and the accrued information size was 577. Conclusions: CSWT could decrease the rate of rehospitalization and MACE among patients with SCAD or RA.