What does this research mean for the field?

While levosimendan shows an imprecise survival benefit versus enoximone, there is overall no robust evidence supporting the use of distinct inotropic or vasodilator therapies to reduce mortality in acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To evaluate the efficacy, safety, and mortality impact of inotropic agents and vasodilator strategies compared with placebo or each other for hemodynamic stabilization in acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome.

January 2, 2014Cochrane library

Inotropic agents and vasodilator strategies for acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome (n=66). Intervention: Inotropic agents (levosimendan) and vasodilator strategies (nitric oxide gas) vs. Placebo or standard treatment (enoximone or dobutamine). Primary outcome: Mortality and morbidity (HR 0.33, 95% CI 0.11 to 0.97).

View Full Paper

Ask AI

Bookmark

Key result

Levosimendan showed an imprecise survival benefit versus enoximone (HR 0.33; 95% CI 0.11-0.97), but overall there are no robust data supporting distinct inotropic or vasodilator therapies in AMI.

Why the study?

Do inotropic agents or vasodilator strategies reduce mortality and morbidity in patients with acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome?

Population

Patients with acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome. 4…

Comparison

Inotropic agents and vasodilator strategies vs Placebo or standard treatment

Design

Systematic_review

Authors

SUSusanne UnverzagtLuther University LWLisa WachsmuthMerseburg University of Applied Sciences KHKatharina HirschInstitute for Quality and Efficiency in Health Care

Discussion

Member takes

Implication

No specific inotrope or vasodilator is supported in AMI with shock; leaves open the need for adequately powered RCTs.

Key Points

To evaluate the efficacy, safety, and mortality impact of inotropic agents and vasodilator strategies compared with placebo or each other for hemodynamic stabilization in acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome.
Systematic search of CENTRAL, MEDLINE, EMBASE, ISI Web of Science, trial registers, and conference proceedings through January 2013 without language restrictions.
Inclusion criteria encompassed randomized controlled trials assessing inotropes or vasodilators in patients with acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome.
Extracted individual hazard ratios and odds ratios with 95% confidence intervals; meta-analysis pooling was not conducted due to high heterogeneity among control interventions.
Four small randomized trials were identified; three trials with high risk of bias evaluated levosimendan across 63 participants (31 levosimendan, 32 controls).
Levosimendan demonstrated an imprecise survival benefit compared to enoximone in one small trial of 32 participants (HR 0.33, 95% CI 0.11 to 0.97), but comparisons with dobutamine or placebo showed highly imprecise effects.
A single randomized trial evaluating vasodilator therapy (nitric oxide gas versus placebo) enrolled only three participants, providing insufficient data to determine clinical efficacy or safety.

Study Design

Type

Systematic Review (n=66)

Structured PICO

Do inotropic agents or vasodilator strategies reduce mortality and morbidity in patients with acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome?

Population

Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) or low cardiac output syndrome (LCOS). 4 RCTs pooling 66 participants.

Intervention

Inotropic agents (levosimendan) and vasodilator strategies (nitric oxide gas)

Comparator

Placebo or standard treatment (enoximone or dobutamine)

Outcome

Mortality and morbidityhard clinical

Main Result

Effect estimate: HR 0.33 (95% CI 0.11 to 0.97)

There is currently no robust evidence to support a specific inotropic or vasodilator drug therapy to reduce mortality in patients with AMI complicated by cardiogenic shock.

Limitations

Very small studies
High overall risk of bias
High heterogeneity between control group interventions
very small studies
high overall risk of bias
high heterogeneity between control group interventions

Cite This Study

Unverzagt et al. (2014) conducted a systematic review in Acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome (n=66). Inotropic agents (levosimendan) and vasodilator strategies (nitric oxide gas) vs. Placebo or standard treatment (enoximone or dobutamine) was evaluated on Mortality and morbidity (HR 0.33, 95% CI 0.11 to 0.97). Levosimendan showed an imprecise survival benefit versus enoximone (HR 0.33; 95% CI 0.11-0.97), but overall there are no robust data supporting distinct inotropic or vasodilator therapies in AMI.

synapsesocial.com/papers/6a143df6f88db7183c59e12f https://doi.org/10.1002/14651858.cd009669.pub2

View Full Paper

Ask AI

Bookmark

Inotropic agents and vasodilator strategies for acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Inotropic agents and vasodilator strategies for acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider