Gut microbial metabolite trimethylamine N-oxide as a novel predictor for adverse cardiovascular events after PCI: a systematic review and dose-response meta-analysis

作者：Chunyu Zhang, Jinyu He, Yujia Huo, Lin Liu, Yong Xie, Yufei Meng, Gang Wei, Li Deng, Yang Jiang, Jian Feng · 发表于：Nutrition Journal · 年份：2025 · DOI：10.1186/s12937-025-01159-9 · 被引用次数：8 · 研究领域：Gut microbiota and health、Tryptophan and brain disorders、Clostridium difficile and Clostridium perfringens research

BACKGROUND: Cardiovascular diseases are the leading cause of mortality worldwide, with acute coronary syndrome (ACS) being particularly fatal. Percutaneous coronary intervention (PCI) is a key treatment for ACS; however, major adverse cardiovascular events (MACE) frequently occur postoperatively. Trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite, has been proposed as an emerging risk factor for cardiovascular disease. This study aims to systematically evaluate TMAO's predictive value for MACE post-PCI and explore its dose-response relationship. METHODS: A comprehensive literature search was conducted in four databases (PubMed, Web of Science, Embase, and the Cochrane Library), including retrospective or prospective cohort studies involving patients undergoing PCI. The primary outcome was MACE, and the secondary outcome was all-cause mortality. A dose-response analysis was conducted using a restricted cubic spline model to explore potential nonlinear associations between TMAO levels and outcomes. Heterogeneity was assessed using the Cochrane Q test and the I² statistic. Subgroup analysis and meta-regression were performed to identify sources of heterogeneity. RESULTS: Eleven studies (comprising 13 independent cohorts) with 11,279 participants were included. Pooled analysis showed a significant association between elevated plasma TMAO levels and an increased risk of MACE after PCI (HR: 1.99, 95%CI: 1.68-2.35, 95%PI: 1.64-2.40, I² = 0%, p < 0.00001). Similarly, ...