Milrinone significantly increased left ventricular ejection fraction (MD 5.69; 95% CI 4.27 to 7.10; p<0.00001) and cardiac output, but did not improve survival in acute heart failure after AMI.
Meta-Analysis
Does milrinone improve outcomes in patients with acute heart failure after acute myocardial infarction?
Milrinone improves hemodynamic parameters such as LVEF and cardiac output in patients with acute heart failure after acute myocardial infarction, but current evidence does not demonstrate a survival benefit.
Effect estimate: MD 5.69 (95% CI 4.27 to 7.10)
p-value: p=<0.00001
Despite advancements in modern medicine, the treatment of acute heart failure (AHF) after acute myocardial infarction (AMI) remains challenging. Milrinone is effective in the treatment of chronic congestive heart failure, but its safety and efficacy in patients with AHF after AMI have not been systematically evaluated. This meta-analysis was performed to assess the safety and efficacy of milrinone in patients with AHF after AMI. We used a pre-designed protocol to search electronic databases for randomized trials assessing milrinone for the treatment of AHF after AMI. Data were abstracted from relevant studies. Heterogeneity was assessed qualitatively using a Q test and quantified using the I(2) statistic. Pooled risk estimates with 95% confidence intervals (CIs) were obtained using fixed-effects models unless substantial heterogeneity was observed (I(2) ≥ 50% and heterogeneity p ≤ 0.1). Four randomized trials met the inclusion criteria. However, there were no significant differences in deaths, blood pressure, premature ventricular contractions, gastrointestinal reactions, or ventricular tachycardia or fibrillation (all p > 0.05) between control group and milrinone treatment group. Pooled estimates showed that milrinone significantly increased the left ventricular ejection fraction (MD 5.69; 95% CI 4.27 to 7.10; p < 0.00001) and cardiac output (MD 0.35, 95% CI: 0.13 to 0.56; p = 0.002, I(2) = 24%). While studies to date are few and limited by small sample sizes and poor quality, they suggest that treatment with milrinone may be safe and effective for patients with AHF after AMI. However, this meta-analysis did not show that milrinone could improve prognosis or the survival rate.
Tang et al. (Tue,) conducted a meta-analysis in Acute heart failure after acute myocardial infarction. Milrinone vs. Control was evaluated on Left ventricular ejection fraction (MD 5.69, 95% CI 4.27 to 7.10, p=<0.00001). Milrinone significantly increased left ventricular ejection fraction (MD 5.69; 95% CI 4.27 to 7.10; p<0.00001) and cardiac output, but did not improve survival in acute heart failure after AMI.