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Table 2 Summary of finding Table for Omega 3 for patients with myocardial infarction

From: Omega 3 fatty acid supplementation after myocardial infarction: a systematic review and meta-analysis

Omega 3 compared to placebo for Patients with AMI

 

Patient or population: Patients with AMI

Intervention: Omega 3

Comparison: Placebo

Outcome â„– of participants (studies)

Relative effect (95% CI)

Anticipated relative effects (95% CI)

Anticipated absolute effects (95% CI)*

Certainty

What happens

 

Without Omega 3 vs Placebo

With Omega 3 vs Placebo

Absolute Difference

All-cause mortality follow up: mean 34 months № of participants: 24314 (11 RCTs)

RR 0.86 (0.72 to 1.02)

14% fewer (28% fewer to 2% more)

8.3%

7.1% (5.9 to 8.5)

0.9% fewer (2.4 fewer to 2.0 more)

⊕ ⊕ ◯◯ LOWa,b,c,d

Omega 3 fatty acids probably may make little or no difference to all-cause mortality

All-cause mortality - Risk of bias subgroup - Low risk of bias follow up: 26 months № of participants: 9949 (5 RCTs)

RR 1.09 (0.87 to 1.35)

9% more (13% fewer to 35% more)

8.3%

9% (7.2 to 11.2)

0.7% more (1.1 fewer to 2.9 more)

⊕ ⊕ ⊕◯ MODERATEe

Omega 3 fatty acids probably make little or no difference to all-cause mortality

Cardiovascular mortality follow up: 34 months № of participants: 19119 (9 RCTs)

RR 0.77 (0.65 to 0.91)

23% fewer (35% fewer to 9% fewer)

6.4%

4.9% (4.1 to 5.8)

1.5% fewer (2.3 fewer to 0.6 fewer)

⊕ ⊕ ◯◯ LOWa,d,f

Omega 3 fatty acids probably may reduce cardiovascular mortality

Cardiovascular mortality - Risk of bias subgroup - Low risk of bias follow up: 13 months № of participants: 11645 (3 RCTs)

RR 0.93 (0.63 to 1.37)

7% fewer (37% fewer to 37% more)

6.4%

6.0% (4.0 to 8.8)

0.4% fewer (2.4 fewer to 2.4 more)

⊕ ⊕ ⊕◯ MODERATEe

Omega 3 fatty acids probably make little or no difference to cardiovascular mortality

Acute myocardial infarction follow up: 41 months № of participants: 13282 (7 RCTs)

RR 0.77 (0.60 to 0.99)

23% fewer (40% fewer to 1% fewer)

9.6%

7.4% (5.7 to 9.5)

2.2% fewer (3.8 fewer to 0.1 fewer)

⊕ ⊕ ◯◯ LOWf,g,h

Omega 3 fatty acids may reduce acute myocardial infarction

Acute myocardial infarction - Low risk of bias subgroup follow up: 18 months № of participants: 6823 (2 RCTs)

RR 1.24 (0.71 to 2.14)

24% more (29% fewer to 14% more)

9.6%

11.8% (6.8 to 20.4)

2.3% more (2.8 fewer to 10.9 more)

⊕ ⊕ ⊕◯ MODERATEe

Omega 3 fatty acids probably make little or no effect on acute myocardial infarction

Ischaemic Stroke follow up: 39 months № of participants: 14262 (5 RCTs)

RR 1.20 (0.66 to 2.19)

20% more (34% fewer to 19% more)

1.2%

1.4% (0.8 to 2.6)

0.2% more (0.4 fewer to 1.4 more)

⊕ ⊕ ◯◯ LOWe,i

Omega 3 fatty acids probably may make little or no difference to stroke

Need of therapeutic revascularization follow up: 35 months № of participants: 15732 (3 RCTs)

RR 1.00 (0.91 to 1.10)

0.0% fewer (9% fewer to 10% more)

20.9%

20.9% (19.0 to 23.0)

0.0% fewer (1.9 fewer to 2.1 more)

⊕ ⊕ ◯◯ LOWe,j

Omega 3 fatty acids probably may make little or no difference to the need of revascularization

Treatment suspension due to adverse events follow up: 28 months № of participants: 8641 (2 RCTs)

RR 1.19 (0.97 to 1.47)

19% more (3% fewer to 47% more)

4.2%

5.0% (4.1 to 6.2)

0.8% more (0.1 fewer to 2.0 more)

⊕ ⊕ ⊕◯ MODERATEe

Omega 3 fatty acids probably make little or no difference to suspension due to adverse events

Cancer follow up: 33 months â„– of participants: 15127 (2 RCTs)k

OR 1.25 (0.94 to 1.66)

25% more (6% fewer to 66% more)

1.2%

1.4% (1.1 to 1.9)

0.3% more (0.1 fewer to 0.7 more)

⊕◯◯◯ VERY LOWe,m

Omega 3 fatty acids probably make little or no difference to suspension due to cancer

  1. *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI Confidenceinterval, RR Risk ratio, OR Odds ratio
  2. GRADE Working Group grades of evidence
  3. High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
  4. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
  5. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
  6. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
  7. Explanations
  8. aThe effect estimate was obtained from trial including six evaluated to have high risk of bias (Burr, De Longeril, Marchioli, Morris, Singh, Tuttle)
  9. bThe apparent benefit for this outcome was influenced by the effect of trials that met our criteria for moderate to high risk of bias. As there was no statistical heterogeneity the certainty was not downgraded a whole point
  10. cThe CI 95% crosses the no effect line (1), including the possibility of benefits and harms. As the 95% CI does not showpossible harms the certainty was not downgraded a whole point (see explanation b). Considering the posibility of drawbacks a thereshold below the no effect line could be set and therefore assuming a lack of benefit on the intervention there could be considered that there should not be downgraded for imprecision. As this thereshold should be set by a guideline pannelpannel we conidered the information to be imprecise
  11. dIt is possible to judge that is risk of publication bias for the moderate to high risk of bias soubgroup (small trials failing to prove effect of the intervention). We did not judge that this analisys would justify downgrading for risk of puclication bias
  12. eThe CI 95% crosses the no effect line (1), including the possibility of benefits and harms. Considering the posibility of drawbacks a thereshold below the no effect line could be set and therefore assuming a lack of benefit on the intervention there could be considered that there should not be downgraded for imprecision. As this thereshold should be set by a guideline pannelpannel we conidered the information to be imprecise
  13. fThe apparent benefit for this outcome was influenced by the effect of trials that met our criteria for moderate to high risk of bias
  14. gThe effect estimate was obtained from trial including five evaluated to have high risk of bias (De Longeril, Marchioli, Morris, Singh, Tuttle)
  15. hAs the 95% CI does not show possible harms the certainty was not downgraded a whole point (see explanation b). Considering the posibility of drawbacks a thereshold below the no effect line could be set and therefore assuming a lack of benefit on the intervention there could be considered that there should not be downgraded for imprecision. As this thereshold should be set by a guideline pannelpannel we conidered the information to be imprecise
  16. iThe effect estimate was obtained from trial including four evaluated to have high risk of bias (Burr, De Longeril, Marchioli, Tuttle)
  17. jThe effect estimate was obtained from trial including two evaluated to have high risk of bias (De Longeril, Marchioli)
  18. kThe follow up was to short to evaluate cancer incidence. The diagnostic procedures to evaluate the incidence of cancer were not clearly described
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BMC Cardiovascular Disorders

ISSN: 1471-2261

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