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Review
. 2020 Jun 30;9(7):2051.
doi: 10.3390/jcm9072051.

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

Mina Karami  1 , Veemal V Hemradj  2 , Dagmar M Ouweneel  1 , Corstiaan A den Uil  3 , Jacqueline Limpens  4 , Luuk C Otterspoor  5 , Alexander P Vlaar  6 , Wim K Lagrand  6 , José P S Henriques  1
Affiliations
Review

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

Mina Karami et al. J Clin Med. .

Abstract

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.

Keywords: cardiogenic shock; inotrope; low cardiac output; myocardial infarction; review; shock; vasopressor.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Forest plot demonstrating short-term (<90 day) mortality of cardiogenic shock patients treated with a vasopressor/inotrope versus a constructed control group.
Figure 3
Figure 3
Forest plot demonstrating long-term (≥90 day) mortality of cardiogenic shock patients treated with a vasopressor/inotrope versus a constructed control group.
See this image and copyright information in PMC

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