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Vasopressors and Inotropes in Acute Myocardial Infarction Related Cardiogenic Shock: A Systematic Review and Meta-Analysis

1
Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
2
Department of Cardiology, Isala, 8025 AB Zwolle, The Netherlands
3
Departments of Cardiology and Intensive Care Medicine, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands
4
Medical Library, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
5
Heart Center Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
6
Department of Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
*
Author to whom correspondence should be addressed.
These two authors contributed equally.
J. Clin. Med. 2020, 9(7), 2051; https://doi.org/10.3390/jcm9072051
Received: 5 May 2020 / Revised: 24 June 2020 / Accepted: 25 June 2020 / Published: 30 June 2020
(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)
Vasopressors and inotropes are routinely used in acute myocardial infarction (AMI) related cardiogenic shock (CS) to improve hemodynamics. We aimed to investigate the effect of routinely used vasopressor and inotropes on mortality in AMI related CS. A systematic search of MEDLINE, EMBASE and CENTRAL was performed up to 20 February 2019. Randomized and observational studies reporting mortality of AMI related CS patients were included. At least one group should have received the vasopressor/inotrope compared with a control group not exposed to the vasopressor/inotrope. Exclusion criteria were case reports, correspondence and studies including only post-cardiac surgery patients. In total, 19 studies (6 RCTs) were included, comprising 2478 CS patients. The overall quality of evidence was graded low. Treatment with adrenaline, noradrenaline, vasopressin, milrinone, levosimendan, dobutamine or dopamine was not associated with a difference in mortality between therapy and control group. We found a trend toward better outcome with levosimendan, compared with control (RR 0.69, 95% CI 0.47–1.00). In conclusion, we found insufficient evidence that routinely used vasopressors and inotropes are associated with reduced mortality in patients with AMI related CS. Considering the limited evidence, this study emphasizes the need for randomized trials with appropriate endpoints and methodology. View Full-Text
Keywords: cardiogenic shock; inotrope; vasopressor; myocardial infarction; low cardiac output; shock; review cardiogenic shock; inotrope; vasopressor; myocardial infarction; low cardiac output; shock; review
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Karami, M.; Hemradj, V.V.; Ouweneel, D.M.; den Uil, C.A.; Limpens, J.; Otterspoor, L.C.; Vlaar, A.P.; Lagrand, W.K.; Henriques, J.P.S. Vasopressors and Inotropes in Acute Myocardial Infarction Related Cardiogenic Shock: A Systematic Review and Meta-Analysis. J. Clin. Med. 2020, 9, 2051.

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