TY - JOUR
T1 - Implications of myocardial infarction on management and outcome in cardiogenic shock
AU - Jung, Richard G.
AU - Di Santo, Pietro
AU - Mathew, Rebecca
AU - Abdel-Razek, Omar
AU - Parlow, Simon
AU - Simard, Trevor
AU - Marbach, Jeffrey A.
AU - Gillmore, Taylor
AU - Mao, Brennan
AU - Bernick, Jordan
AU - Theriault-Lauzier, Pascal
AU - Fu, Angel
AU - Lau, Lawrence
AU - Motazedian, Pouya
AU - Russo, Juan J.
AU - Labinaz, Marino
AU - Hibbert, Benjamin
N1 - Publisher Copyright:
© 2021 The Authors.
PY - 2021/11/2
Y1 - 2021/11/2
N2 - BACKGROUND: The randomized DOREMI (Dobutamine Compared to Milrinone) clinical trial evaluated the efficacy and safety of milrinone and dobutamine in patients with cardiogenic shock. Whether the results remain consistent when stratified by acute myocardial infarction remains unknown. In this substudy, we sought to evaluate differences in clinical management and outcomes of acute myocardial infarction complicated by cardiogenic shock (AMICS) versus non-AMICS. METHODS AND RESULTS: Patients in cardiogenic shock (n=192) were randomized 1:1 to dobutamine or milrinone. The primary composite end point in this subgroup analysis was all-cause in-hospital mortality, cardiac arrest, non-fatal myocardial infarc-tion, cerebrovascular accident, the need for mechanical circulatory support, or initiation of renal replacement therapy (RRT) at 30-days. Outcomes were evaluated in patients with (n=65) and without (n=127) AMICS. The primary composite end point was significantly higher in AMICS versus non-AMICS (hazard ratio [HR], 2.21; 95% CI, 1.47– 3.30; P=0.0001). The primary end point was driven by increased rates of all-cause mortality, mechanical circulatory support, and RRT. No differences in other secondary outcomes including cardiac arrest or cerebrovascular accident were observed. AMICS remained associated with the primary composite outcome, 30-day mortality, and RRT after adjustment for age, sex, procedural contrast use, multives-sel disease, and inotrope type. CONCLUSIONS: AMI was associated with increased rates of adverse clinical outcomes in cardiogenic shock along with increased rates of mortality and initiation of mechanical circulatory support and RRT. Contrast administration during revascu-larization likely contributes to increased rates of RRT. Heterogeneity of outcomes in AMICS versus non-AMICS highlights the need to study interventions in specific subgroups of cardiogenic shock.
AB - BACKGROUND: The randomized DOREMI (Dobutamine Compared to Milrinone) clinical trial evaluated the efficacy and safety of milrinone and dobutamine in patients with cardiogenic shock. Whether the results remain consistent when stratified by acute myocardial infarction remains unknown. In this substudy, we sought to evaluate differences in clinical management and outcomes of acute myocardial infarction complicated by cardiogenic shock (AMICS) versus non-AMICS. METHODS AND RESULTS: Patients in cardiogenic shock (n=192) were randomized 1:1 to dobutamine or milrinone. The primary composite end point in this subgroup analysis was all-cause in-hospital mortality, cardiac arrest, non-fatal myocardial infarc-tion, cerebrovascular accident, the need for mechanical circulatory support, or initiation of renal replacement therapy (RRT) at 30-days. Outcomes were evaluated in patients with (n=65) and without (n=127) AMICS. The primary composite end point was significantly higher in AMICS versus non-AMICS (hazard ratio [HR], 2.21; 95% CI, 1.47– 3.30; P=0.0001). The primary end point was driven by increased rates of all-cause mortality, mechanical circulatory support, and RRT. No differences in other secondary outcomes including cardiac arrest or cerebrovascular accident were observed. AMICS remained associated with the primary composite outcome, 30-day mortality, and RRT after adjustment for age, sex, procedural contrast use, multives-sel disease, and inotrope type. CONCLUSIONS: AMI was associated with increased rates of adverse clinical outcomes in cardiogenic shock along with increased rates of mortality and initiation of mechanical circulatory support and RRT. Contrast administration during revascu-larization likely contributes to increased rates of RRT. Heterogeneity of outcomes in AMICS versus non-AMICS highlights the need to study interventions in specific subgroups of cardiogenic shock.
KW - Acute myocardial infarction
KW - Cardiogenic shock
KW - Inotrope
KW - Mechanical circulatory support
KW - Renal replacement therapy
KW - Revascularization
UR - http://www.scopus.com/inward/record.url?scp=85120799114&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85120799114&partnerID=8YFLogxK
U2 - 10.1161/JAHA.121.021570
DO - 10.1161/JAHA.121.021570
M3 - Article
C2 - 34713704
AN - SCOPUS:85120799114
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 21
M1 - e021570
ER -