The following article is a part of conference coverage from the American College of Cardiology’s 70th Annual Scientific Session & Expo is being held virtually from May 15 to 17, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by clinicians and scientists in the field. Check back for more from the ACC 2021 .
Inotropes are associated with improved survival outcomes in patients with cardiogenic shock due to acute myocardial infarction (CS-AMI), independent of the effect of mechanical circulatory support (MCS) devices and shock severity. That is the conclusion of researchers who presented their study results at the American College of Cardiology 2021 Annual Meeting, held virtually May 15-17, 2021.
To date, no study has evaluated the association of vasopressors and inotropes with mortality independent of risks associated with MCS, hypoperfusion laboratory markers, or patient vital signs, according to the study authors.
To address the question of benefit with inotropes vs vasopressors in the setting of CS-AMI, the researchers, from Washington University School of Medicine’s Cardiovascular Division, analyzed data from 5959 patients with CS-AMI treated at Barnes-Jewish Hospital in St. Louis, Missouri over a period of 20 years (December 1999 to March 2020). The primary outcome of the study was 30-day mortality.
Within the study cohort, 26% of patients died within 30 days. Results of a Kaplan-Meier analysis showed that use of vasopressors was associated with higher mortality (hazard ratio [HR], 1.73); the researchers noted an increasing mortality incidence associated with use of an increasing number of vasopressors (1 vs 2 vs 3 agents).
Conversely, use of inotropes was associated with improved survival (HR, 0.73).
Following adjustment for the use of mechanical circulatory devices, hypoperfusion laboratory markers, patient vital signs, comorbidities, and in-hospital procedures, therapy with inotropes was associated with improved survival compared with vasopressor therapy (odds ratio, 0.58 vs 0.20; 95% CI, 1.89-2.55 vs 0.51-0.66).
“We observed improved survival associated with inotropes independent of [mechanical circulatory] devices and shock severity,” the researchers concluded. “These findings, if tested prospectively, may have important implications on medical management in cardiogenic shock.”
Aggarwal A, Thangam M, Bach R, et al. Comparative effectiveness of vasopressors and inotropes in cardiogenic shock. Presented at: American College of Cardiology (ACC) 2021 Annual Meeting; May 15-17, 2021. Poster 101.
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