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

Autor:	Alexander P.J. Vlaar, Wim K. Lagrand, Jacqueline Limpens, Veemal Hemradj, Mina Karami, Dagmar M. Ouweneel, Luuk C. Otterspoor, Corstiaan A. den Uil, José P.S. Henriques
Přispěvatelé:	Cardiology, Intensive Care
Jazyk:	angličtina
Rok vydání:	2020
Předmět:	Inotrope medicine.medical_specialty lcsh:Medicine Review vasopressor shock 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine medicine 030212 general & internal medicine Myocardial infarction low cardiac output business.industry Cardiogenic shock cardiogenic shock lcsh:R General Medicine Levosimendan medicine.disease myocardial infarction Shock (circulatory) Cardiology inotrope Observational study Dobutamine medicine.symptom business medicine.drug
Zdroj:	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 2020, ' Vasopressors and inotropes in acute myocardial infarction related cardiogenic shock : A systematic review and meta-analysis ', Clinical Chemistry, vol. 9, no. 7, pp. 1-12 . https://doi.org/10.3390/jcm9072051 Journal of Clinical Medicine, Vol 9, Iss 2051, p 2051 (2020) Journal of Clinical Medicine, 9(7):2051. Multidisciplinary Digital Publishing Institute (MDPI) Journal of Clinical Medicine
ISSN:	2077-0383
DOI:	10.3390/jcm9072051
Popis:	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.
Databáze:	OpenAIRE
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