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. 2013 Aug 15;8(8):e71659.
doi: 10.1371/journal.pone.0071659. eCollection 2013.

The effectiveness of inodilators in reducing short term mortality among patient with severe cardiogenic shock: a propensity-based analysis

Romain Pirracchio  1 , Jiri Parenica, Matthieu Resche Rigon, Sylvie Chevret, Jindrich Spinar, Jiri Jarkovsky, Faiez Zannad, François Alla, Alexandre Mebazaa; GREAT network
Affiliations

The effectiveness of inodilators in reducing short term mortality among patient with severe cardiogenic shock: a propensity-based analysis

Romain Pirracchio et al. PLoS One. .

Erratum in

  • PLoS One. 2013;8(12). doi:10.1371/annotation/add6bc4f-dec0-4c95-a609-67563469b831

Abstract

Background: The best catecholamine regimen for cardiogenic shock has been poorly evaluated. When a vasopressor is required to treat patients with the most severe form of cardiogenic shock, whether inodilators should be added or whether inopressors can be used alone has not been established. The purpose of this study was to compare the impact of these two strategies on short-term mortality in patients with severe cardiogenic shocks.

Methods and results: Three observational cohorts of patients with decompensated heart failure were pooled to comprise a total of 1,272 patients with cardiogenic shocks. Of these 1,272 patients, 988 were considered to be severe because they required a vasopressor during the first 24 hours. We developed a propensity-score (PS) model to predict the individual probability of receiving one of the two regimens (inopressors alone or a combination) conditionally on baseline-measured covariates. The benefit of the treatment regimen on the mortality rate was estimated by fitting a weighted Cox regression model. A total of 643 patients (65.1%) died within the first 30 days (inopressors alone: 293 (72.0%); inopressors and inodilators: 350 (60.0%)). After PS weighting, we observed that the use of an inopressor plus an inodilator was associated with an improved short-term mortality (HR: 0.66 [0.55-0.80]) compared to inopressors alone.

Conclusions: In the most severe forms of cardiogenic shock where a vasopressor is immediately required, adding an inodilator may improve short-term mortality. This result should be confirmed in a randomized, controlled trial.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flowchart.
Combined regimen stands for inopressors and inodilators; *patients excluded for missing data concerning the treatment regimen, the outcome or the length of hospital stay; $patients included in the final analysis.
Figure 2
Figure 2. Standard differences in the major baseline covariates between the two treatment regimens.
NYHA, New York Heart Association; PCI, percutaneous intervention; IABP, intra-aortic balloon pump; CPAP, continuous positive airway pressure; HR, heart rate; BNP, B-type natriuretic peptide; ACS, acute coronary syndrome; CAD, coronary artery disease; CHF, chronic heart failure; ACEI/ARB, angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers; BB, beta blockers; SBP, systolic blood pressure; LVEF, left ventricular ejection fraction.
Figure 3
Figure 3. Kaplan-Meier representation of mortality: A.
As evaluated in the original pooled datasets; B. as evaluated in the pooled datasets after PS weighting. (Combined regimen stands for inopressors and inodilators).
Figure 4
Figure 4. Subgroup PS-weighted analyses of the inopressors and inodilators vs. inopressors alone on short-term mortality.
HR, hazard ratios; PS, propensity score; SBP, systolic blood pressure; ACS, acute coronary syndrome.
See this image and copyright information in PMC

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