Key result
Dobutamine shows no 30-day mortality difference versus milrinone in inferior STEMI with suspected RV involvement.
Why the study?
Evidence guiding the choice between inotropic agents in inferior STEMI complicated by right ventricular involvement remains limited.
Does dobutamine compared to milrinone reduce 30-day mortality in patients with inferior STEMI and suspected right ventricular involvement?
Cohort (n=211)
No
Does dobutamine compared to milrinone reduce 30-day mortality in patients with inferior STEMI and suspected right ventricular involvement?
Hazard Ratio: 0.612 (95% CI 0.316–1.187)
Absolute Event Rate: 25.5% vs 29.5%
p-value: p=0.153
In patients with inferior STEMI and suspected RVMI, the choice between dobutamine and milrinone did not significantly impact 30-day mortality, though dobutamine was associated with shorter inotropic support duration among survivors.
No mortality difference observed; leaves open optimal inotrope choice in inferior STEMI with RV involvement pending randomized trials.
Background: Inferior ST-segment elevation myocardial infarction (STEMI) complicated by right ventricular involvement (RVMI) leads to right-heart-dominant failure and a higher incidence of cardiogenic shock (CS). Evidence guiding the choice between inotropic agents in this specific phenotype remains limited. Methods: This single-center retrospective cohort study included 211 patients with inferior STEMI and suspected RVMI treated with either dobutamine (n = 55) or milrinone (n = 156) between June 2009 and June 2025. The primary outcome was 30-day mortality. Secondary outcomes included duration of inotropic support and hospital length of stay. Confounding and missing data were addressed using multiple imputation, multivariable Cox regression, inverse probability of treatment weighting, and sensitivity analyses. Results: The dobutamine group had more severe hemodynamic and electrical instability, while the milrinone group exhibited greater left ventricular dysfunction. The 30-day mortality rates were 25.5% for dobutamine and 29.5% for milrinone. No significant difference was found in unadjusted (HR 0.863; 95% CI 0.475-1.570; P = 0.632) or multivariable-adjusted Cox analysis (HR 0.612; 95% CI 0.316-1.187; P = 0.153), with results remaining consistent across multiple sensitivity and propensity-based analyses. Notably, among survivors, the duration of inotropic support was significantly shorter in the dobutamine group (3.1 vs. 5.0 days; adjusted β = -1.805; 95% CI -3.147 to -0.463; P = 0.009). Conclusion: In patients with inferior STEMI and suspected RVMI, no statistically significant difference in 30-day mortality was detected between dobutamine and milrinone, though the study was underpowered to establish equivalence. Dobutamine was associated with a shorter duration of support among survivors despite its application in more unstable patients. Inotrope selection should therefore be individualized based on the patient's hemodynamic phenotypes.
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Wang et al. (2026) conducted a cohort in Inferior ST-segment elevation myocardial infarction (STEMI) with suspected right ventricular involvement (n=211). Dobutamine vs. Milrinone was evaluated on 30-day all-cause mortality (HR 0.612, 95% CI 0.316-1.187, p=0.153). Dobutamine showed no statistically significant difference in 30-day all-cause mortality compared to milrinone in patients with inferior STEMI and suspected right ventricular involvement (HR 0.612).
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